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HIV mortality due to comorbidity, factors unrelated to HIV disease

Lohse N. J Acquir Immune Defic Syndr.2011;doi:10.1097/QAI.0b013e31821d34ed.

Issue: August 2011

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Nearly half of deaths among HIV-infected individuals in a health care setting with free access to highly active antiretroviral therapy resulted from factors unrelated to HIV, including comorbidity acquired before diagnosis, hepatitis C virus infection and background mortality, according to Danish researchers.

Nicolai, Lohse, MD, PhD, of the department of clinical epidemiology of Århus University Hospital in Denmark, and colleagues evaluated the affect of comorbidity acquired before HIV diagnosis on mortality in HIV-infected individuals in a study published in the Journal of Acquired Immune Deficiency Syndromes.

Lohse and colleagues compared 1,638 HIV-infected adults with a cohort of 156,506 adults from the general population during the Danish population based cohort study. Data were pooled from the Danish National Patient Registry and the Danish Civil Registration System for comorbidity history and vital statistics.

The researchers estimated the affect of Charlson comorbidity index (CCI) and hepatitis C virus (HCV) coinfection on mortality, and then assessed the proportional impact of comorbidity on mortality.

Based on these results, CCI comorbidity was present before HIV diagnosis in 11.3% of those with HIV, and 8.0% of those from the general population.

The risk for death in HIV patients with at least one CCI point was 1.84 times higher than in those with no CCI points (adjusted mortality rate ratio, 95% CI: 1.32-2.57), according to the study.

The annual mortality risk for HIV patients vs. general population was as follows:

• 0 CCI points: 1.70% (1.44-2.00) vs. 0.27% (0.26-0.28).
• 1 CCI point: 4.37% (3.01-6.32) vs. 1.36% (1.26-1.47).
• 2 CCI points: 8.06% (4.94-13.16) vs. 2.44% (2.22-2.68).
• 3 or more CCI points: 10.15% (5.08-20.30) vs. 5.84% (5.19-6.58).

Further, the researchers reported that 45% of total mortality in the HIV-infected individuals stemmed from comorbidity acquired before HIV, HCV, and background mortality.

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