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The Coding Causes of Death in HIV (CoDe) Project: Initial Results and Evaluation of Methodology

Kowalska, Justyna D.a; Friis-Møller, Ninaa; Kirk, Olea,b; Bannister, Wendyc; Mocroft, Amandac; Sabin, Carolinec; Reiss, Peterd; Gill, Johne; Lewden, Charlottef; Phillips, Andrewc; D'Arminio Monforte, Antonellag; Law, Matthewh; Sterne, Jonathani; De Wit, Stephanej; Lundgren, Jens D.a,bfor The CoDe Working Group and the D:A:D Study Group

doi: 10.1097/EDE.0b013e31821b5332
Infectious Disease: Original Article

Background: The Coding Causes of Death in HIV (CoDe) Project aims to deliver a standardized method for coding the underlying cause of death in HIV-positive persons, suitable for clinical trials and epidemiologic studies.

Methods: The project incorporates detailed data collection, a classification system, and a centralized adjudication process performed by 2 independent reviewers. The methodology was tested in the Data Collection on Adverse events of Anti-HIV Drugs Study, and independent reviews of causes of death were compared. Logistic regression models identified factors associated with initial agreement by reviewers on underlying cause of death.

Results: A total of 491 reported fatal cases were adjudicated; in only 5% of cases the cause of death remained undetermined after adjudication. Reviewers initially agreed on the underlying cause for 339 (69%) deaths. As compared with deaths due to AIDS-related causes, the odds of agreement were more than 80% lower when deaths were ultimately deemed to be due to non-AIDS-related causes (odds ratio = 0.17 [95% confidence interval = 0.08–0.37]) or undetermined causes (0.11 [0.04–0.36]). The odds of initial agreement were also lower for deaths occurring in subjects with hypertension (0.43 [0.22–0.85]) and depression (0.43 [0.23–0.80]).

Conclusions: The extent and format of data collected in the CoDe Project appear to be sufficient for an informed review, and the proposed coding scheme is adequate for obtaining an underlying cause of death.


From the aCopenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark; bDepartment of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark; cUniversity College London Medical School, Royal Free Campus, London, United Kingdom; dHIV Monitoring Foundation, Academic Medical Center, Amsterdam, the Netherlands; eS Alberta HIV Clinic, Sheldon M Chumir Health Centre, Calgary, Canada; fBordeaux School of Public Health, Institut de Santé Publique, d'Epidémiologie et de Développement, Bordeaux, France; gHospital San Paolo, University of Milan, Milan, Italy; hNational Centre in HIV Epidemiology and Clinical Research, Sydney, Australia; iDepartment of Social Medicine, University of Bristol, Bristol, United Kingdom; and jDepartment of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre Hospital, Brussels, Belgium.

Submitted 13 September 2010; accepted 20 January 2011; posted 26 April 2011.

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Correspondence: Justyna D. Kowalska, Copenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, The Panum Institute/Building 21.1, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.