Most HIV mortality now due to non-AIDS-related comorbidities
Click Here to Manage Email Alerts
Key takeaways:
- Three-quarters of deaths among people with HIV in Europe and North America were not AIDS related.
- The age of death among people with HIV increased significantly from 42.2 years in 1999 to 56.2 years in 2019.
SEATTLE — Because people with HIV who are being successfully treated with ART have a close to normal life expectancy, most deaths among those with HIV are now caused by unrelated comorbidities, a study found.
“The causes of mortality are changing as the population of persons with HIV ages,” Adam Trickey, MSc, a Sir Henry Wellcome Research Fellow at the University of Bristol in the United Kingdom, said during a recent presentation at the Conference on Retroviruses and Opportunistic Infections. “Comorbidities are more common among persons with HIV than in the general population.”
Trickey said the aim of the study was to describe changes in the death rate among people with HIV and to describe changes in their distribution among various populations of people.
Guidelines and initiatives in the last decade have pushed providers to initiate ART in patients as soon after HIV diagnosis as possible. Over time, studies have shown that ART initiation and adherence has slowly narrowed the life expectancy gap between people with HIV and people without HIV to zero.
Because mortality rates among people with HIV have fallen since effective ART became available in 1996 and the percentage of people with HIV dying of AIDS-related causes has dropped, Trickey and colleagues sought to clarify the modern most common causes of death among those with HIV.
Using data on 189,916 people with HIV from the Antiretroviral Therapy Cohort Collaboration, they analyzed longitudinal patterns of death in Europe and North America among people with HIV aged 16 years or older who started ART between 1996 and 2019.
Over the course of the study period, 16,897 of the participants died, with the age of death increasing “significantly,” Trickey said, from 42.2 years in the 1996 to 1999 period to 56.2 years in the 2016 to 2019 period.
The rate of all-cause mortality per 1,000 person-years decreased from 16.9 during 1996 to 1999 to 7.9 during 2016 to 2019. The researchers were able to assign a cause of death about 80% of the time, with roughly one-quarter being AIDS related, Trickey said.
Among specific comorbidities, he noted that non-AIDS and hepatitis cancer-linked deaths increased from 5% to 19%, and that non-AIDS liver- and cardiovascular-related deaths had also increased.
Trickey also said the researchers were surprised to find that although there was a decrease in substance abuse-related deaths among the data’s European cohorts, there was an increase in substance abuse-related deaths among the North American cohorts.
“Improvement in HIV care and ART have led to reductions in nearly all major causes of death among adults on ART, particularly age-related deaths,” Trickey said. “Most mortality is not due to AIDS-related causes, [it is] mostly related to comorbidities. So, this highlights the need to further reduce mortality by focusing in particular on prevention, screening and treatment of comorbidities, which are still highly prevalent in this population.”
Collapse
Trickey A, et al. Causes of death among adults with HIV on ART in Europe and North America: 1996-2019. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 19-22, 2023; Seattle.
Click Here to Manage Email Alerts