Changing Patterns in Causes of Death After ART Initiation

Keith Henry, MD

Deaths from AIDS-related causes decreased, while those from non-AIDS cancers increased, with persistent effects of CD4-cell count and viral suppression on mortality patterns.

The introduction of effective antiretroviral therapy (ART) has dramatically decreased AIDS-related mortality, thereby increasing life expectancy and rates of death from non-AIDS conditions (e.g., non-AIDS cancers, liver disease, cardiovascular disease) among HIV-infected individuals. In a recent study involving 16 cohorts in Europe and North America, researchers assessed the changes in patterns of death over time following ART initiation.

Eligibility requirements included age ≥16, no previous ART exposure, initiation of an ART regimen that included ≥3 drugs, and follow-up between 1996 and 2009. Information was collected on patient demographics, transmission-risk group, and clinical characteristics, with a focus on causes of death and key time-of-death parameters (i.e., time since starting ART, whether on ART at time of death, and latest CD4-cell count).

Of the 65,121 patients eligible for analysis (median age, 37; median CD4 count, 217 cells/mm3; median viral load, 70,000 copies/mL), 4237 (6.5%) died during 327,535 person-years of follow-up (overall mortality rate, 1.3%/year). Mortality from AIDS decreased with time since starting ART, while mortality from non-AIDS malignancies increased. Age increased the risk for cardiovascular disease and cancer deaths. Intravenous drug users had higher mortality overall and were particularly likely to die from liver-related causes. Baseline and 12-month CD4-cell counts were associated with risk for death from AIDS, non-AIDS infections, and non-AIDS malignancies. Persistent viremia was associated with death from AIDS, non-AIDS infection, and various other causes.

Citation(s):

Ingle SM et al. Impact of risk factors for specific causes of death in the first and subsequent years of ART among HIV-infected patients. Clin Infect Dis 2014 Apr 24; [e-pub ahead of print].