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The Body Covers: The 7th Conference on Retroviruses and Opportunistic Infections
Session 62
Trends in HIV-Associated Mortality February 1, 2000
Poster 460: Is HAART Enough?Are patients dying with better viral loads and CD4+ counts? This analysis of a cohort of 1,172 patients by James Witik from Hahnemann University shows a 32% increase in death rate between 1998 and 1999 in spite of improvements in viral load response and use of more antiretroviral drugs than previously. Patients died, although they were virologically and immunologically "healthier." In 1999, 44% of those who died had viral load <5000 copies/µl and 30% died with viral load <500 copies/ml.The most common cause of death was "wasting syndrome" (22%), cirrhosis due to hepatitis C (19%), and mycobacterial disease (15%). Wasting syndrome was felt to be a generic diagnosis including death without clear etiology. The increase was greatest in women, who accounted for 22% of deaths in 1998, but 56% in 1999. This cohort is 70% African-American, 9% Hispanic, and 37% female. This is one of several reports that are beginning to show an upturn in death, or at least a leveling off of the mortality decline seen in the first years of protease inhibitor use. It is notable that patients seem to be dying less frequently of "classic" opportunistic infections, and more frequently without clear etiology consistent with multi-organ failure, or complications of hepatitis co-infection.
Poster 463: The Changing Spectrum of HIV Mortality: Analysis of 249 Deaths from 1995-1999This is yet another study of mortality in patients who, by CD4+ and viral load, were doing better by some parameters, yet died of "non-HIV" related illnesses. In this study, the median CD4+ count prior to death was 75 cells/µl in 1999 compared with 0 in 1995 and 10 in 1996. The proportion of patients with viral load <400 copies/ml prior to death was 19% in 1999 compared with 0 in 1996. Fewer patients had an opportunistic infection prior to death (48% in 1999 vs. 74% in 1996), and 71% of patients were on HAART at the time of death. End organ disease (renal, liver, pancreas, heart, pulmonary, and neurologic) was the most common cause of death, with decreased numbers of opportunistic infections. The absolute number of deaths in 1999 was 32 compared with 20 in 1998.
Poster 473: Primary HIV Infections Associated with Oral TransmissionThis study of patients with primary infection in San Francisco attempted to establish the proportion of patients who were infected through oral sex. Of 122 patients with primary infection from June 1996 to June 1999, 20 cases were initially felt to be possibly due to oral sex. After further evaluation, all but eight were ultimately reclassified. Eight cases (7.8%) were felt to be "likely" due to oral sex.In a survey about attitudes toward oral sex, 85% who had oral sex without a condom said they did so because they felt the practice to be of little risk. While there have been numerous articles in the popular press questioning whether oral sex was risky, it appears clear that HIV is transmitted through oral sex, although less frequently than through other routes. This report is important because it highlights an important public health issue that is widely misunderstood. While less risky than anal intercourse, oral sex is clearly not "safe" and places participants at risk for acquiring HIV infection.
This article was provided by The Body PRO. Copyright © Body Health Resources Corporation. All rights reserved.
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