Causes of Death Shift Over Time

The wider availability of protease inhibitors in North America and Western Europe has led to a dramatic fall in AIDS-related deaths. Yet, highly active antiretroviral therapy (HAART) is not a cure; and some people with HIV/AIDS (PHAs), particularly those with low incomes, are more likely to die than others. To find out if causes of death in people with AIDS (PWAs) have changed since HAART became available in 1996, researchers in different parts of the world are conducting studies. Here's one report from a U.S. hospital, Cook County Hospital in Chicago, which serves a low-income population.

Researchers at this hospital reviewed medical records of 98 people with AIDS who died at that institution between January 1998 and September 2000. Overall, about 3% of PWAs died in the year 2000 compared with a 5% death rate among PWAs in 1995. HAART was largely unavailable in 1995.

The profile of the 98 subjects at the time they entered the hospital is as follows:

• 28% female, 72% male
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• Average age was about 40 years

• 79% were active substance users

• 53% were co-infected with hepatitis C virus

• 44% were taking anti-HIV medications

• Average CD4+ count -- 95 cells

• Average viral load -- 119,000 copies

According to the researchers, subjects who were hospitalized with life-threatening infections were likely to have the following profile:

• Female

• Hepatitis C negative

• Did not know that they were HIV positive

The most common causes of death for patients hospitalized for infections were caused by complications from cancer or lung problems. While we're not going to list the cause of all 98 deaths here, commonly seen AIDS-related infections included:

• PCP (pneumocystis carinii pneumonia) -- 13 subjects

• TB (tuberculosis) -- 3 subjects

• MAC (Mycobacterium avium complex) -- 3 subjects

• Toxo (toxoplasmosis) -- 2 subjects

• Fungal infection of the lungs -- 1 subject

• Herpes infection of the brain -- 1 subject

Commonly seen cancers that led to death included:

• Lymphoma -- 6 subjects

• Lung cancer -- 2 subjects

• Cervical cancer -- 2 subjects

• Liver cancer -- 1 subject

• Cancer of the throat -- 1 subject

Other causes of death included the following:

• Blood poisoning -- 10 subjects

• Bacterial pneumonia -- 13 subjects

• Liver failure -- 11 subjects

• Heart problems -- 11 subjects

According to the researchers, as many as 38% of subjects did not have life-threatening infections and were dying of complications due to severe liver and kidney damage as well as bacterial infections. The same group of doctors who did this study conducted an earlier study at a nearby prestigious private hospital, Rush-Presbyterian St. Luke's Medical Center, and found that death rates among HIV positive patients were lower there than seen at the hospital that treated low income PHAs. While HAART is clearly beneficial, PWAs with low incomes are more likely to die than those with higher incomes. While the results from this study may seem obvious, health policy planners need to keep them in mind when allocating resources to the health care and social services sectors.

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