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Why are ppl with hiv/aids still dying in 2005 by the thousands in the US.
Sep 24, 2005

Hello I have been poz for 6 yrs now and i still worry about dying all the time. I wonder how i will die. When i will die. What are the main causes of death in the US amongst hivers. Is it resistance, late treatment, refusal of meds, organ failure, adverse affects from the drugs, no access to the drugs. If we would figure out percentages on these causes of death maybe we could reduce them. Also are there any US states or US territories that are particularly hard hit with death rates? We should figure out why. Many docs say we could live a normal or near normal lifespan. Is it plausible for someone my age who hasn't started meds and has access to them, and plans to start them btwn 250 and 300, to live another 30 yrs? I am 25 and i know the avg age of death is around 76, could i live to be 60 - that's near normal - or will these drugs kill me before then? I wish we knew more about this. It's so hard for me to plan a future. I graduated from college this yr and i plan on starting meds in the next 6 months. I feel like i am afraid to make major life decisions. What is your experience with patients since the begining of the heart era and their prognosis?

Response from Dr. Young

Thanks for your thoughtful post.

The World Health Organization and Centers for Disease Control estimate that there are about 40 million persons living with HIV/AIDS in the world; 1 million persons in the US. Most recent estimates indicate that there are approximately 3 million deaths worldwide; about 16,000 deaths in the US. This represents a mortality rate of about 1.6% per year.

This death rate is remarkably lower than that in the ~10% per year (~30% per year for AIDS patients) pre-HAART era- remarkably consistent with the estimated mortality rate in our CDC-sponsored HOPS cohort. The relevancy of this multi-thousand patient cohort is that there is a wide mixture of patients and clinical treatment settings. Furthermore, a recent presentation of the causes of death in the HOPS cohort showed that in the past several years, there has been a dramatic reduction in the AIDS-related mortality, replaced by non-AIDS mortality (cancer, cardiovascular disease, liver disease and suicide). Indeed, these causes of death tend to reflect the causes of mortality in a non-HIV-infected population of persons.

It is because of this revelation that there is a hightened awareness of the need for other more conventional preventive medicine strategies- smoking cessation, blood pressure and diabetes care; psychiatric care and the like. Still, I'm sure that there'll still be much more to learn.

This doesn't mean that all AIDS deaths have been eliminated, simply that with improved medical intervention, we've been able to prevent and successfully treat those things that used to result in death.

Further, we haven't been sucessful at all in prevention of new cases- there are those unfortunate patients that present with very late-stage disease or for any one of a variety of reasons fail to (or refuse to) get access to care.

In your situation, I do expect you to live for many more decades. Medications for HIV, while expensive (but usually covered in our country- at least for now), are well tolerated and long-term studies haven't demonstrated significant irreversible toxicity. If you have access to experienced HIV care and medications, there's no need not to plan for the future (including retirement). I have a whole cast of patients who are doing just that.

Good luck, good health to you. BY



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