Skip Navigation LinksHome > September 2008 - Volume 336 - Issue 3 > Causes of Death in the Era of Highly Active Antiretroviral T...
American Journal of the Medical Sciences:
doi: 10.1097/MAJ.0b013e31815d4408
Articles

Causes of Death in the Era of Highly Active Antiretroviral Therapy: A Retrospective Analysis of a Hybrid Hematology-Oncology and HIV Practice and the Seattle/King County Adult/Adolescent Spectrum of HIV-Related Diseases Project.

UHLENKOTT, MATTHEW C. BA; BUSKIN, SUSAN E. PhD; KAHLE, ERIN M. MPH; BARASH, ELIZABETH MPH; ABOULAFIA, DAVID M. MD

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Abstract

Background: HIV-infected patients continue to die in the era of highly active antiretroviral therapy (HAART).

Objective: To describe the cause of mortality in the HAART era between 2 cohorts by conducting a comparative retrospective analysis.

Methods: The Virginia Mason Medical Center (VMMC) cohort was composed of 60 died HIV-infected patients from 600 patients. The second cohort was comprised of 351 died patients from the Seattle portion of the Adult and Adolescent Spectrum of Diseases Project (Seattle-ASD) of 4721 patients. Among the abstracted data were the conditions present at death, defined as any major cause of morbidity present at death for both cohorts.

Results: Non-AIDS defining illnesses (non-ADI) were a major source of mortality in 60% and 45% for the VMMC and Seattle-ASD cohorts, respectively. The most common fatal non-ADI in both cohorts were cancer (7% and 19%), bacterial infections (15%), and liver failure (9% and 14%). Cancer (10%) and wasting (7%) were prominent fatal ADI in both cohorts. In each cohort, patients died despite a nondetectable HIV viral load and a CD4+ lymphocyte count >200 cells/μL. This included 11 of 60 (18%) VMMC patients (all of whom died of non-ADI) and 35 of 351 (10%) Seattle-ASD patients (81% died with non-ADI).

Conclusions: In 2 well-characterized urban HIV cohorts, non-ADI were a major cause of mortality in the HAART era. A substantial number of these patients died despite nondetectable HIV viral loads and reasonably well-preserved immune function measured by CD4+ cell counts.

© Copyright 2008 Southern Society for Clinical Investigation

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