Comparisons of Causes of Death and Mortality Rates Among HIV-Infected Persons: Analysis of the Pre-, Early, and Late HAART (Highly Active Antiretroviral Therapy) Eras

HIV mortality rates have declined dramatically in the HAART era. In the current study, researchers evaluated HIV-infected US military beneficiaries, a population with open access to medical care and low drug use and hepatitis C coinfection rates, to assess causes of death and mortality rates during the pre-, early, and late HAART eras (1990-96, 1997-1999 and 2000-2003, respectively).

The number of deaths declined over the period of study, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era and 78 deaths in the late HAART era (P<0.01). The annual mortality rate peaked in 1995, at 10.3/100 patients, and then declined to less than 2 deaths/100 patients in the late HAART era (P<0.01).

The proportion of deaths attributable to infection decreased though it remained the top cause of death in the cohort, followed by cancer. In comparing post-HAART to pre-HAART eras, an increasing proportion of deaths were non-HIV related (32 percent vs. 9 percent; P<0.01), including cardiac disease (22 percent vs. 8 percent; P<0.01) and trauma (8 percent vs. 2 percent; P=0.01). An increasing proportion was also related to liver disease, although the numbers were small.

"Despite increasing concerns regarding antiretroviral resistance, the death rate among HIV-infected persons in our cohort continues to decline," concluded researchers. "Our data show a lower death rate than that reported among many other US HIV-infected populations; this may be the result of open access to health care. A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents."

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