Causes of Death for People With HIV

[Jim Allen]

An interesting enough read, nothing shocking though.

End of the day we are all going to die of something. In the meantime, I'll enjoy the time the best I can, and as for my health ill focus on what is within my control, so a balanced diet, exercise, cutting out bad habits and treating any issues early.

POZ.com article in full: https://www.poz.com/article/changing-causes-death-among-people-hiv

In brief:

All-cause mortality dropped among people with HIV in high-income countries over the past three decades, and the causes of death are shifting, but all groups have not benefited equally, according to recent studies.

Mortality rates for people with HIV began to decline dramatically with the advent of highly active antiretroviral therapy (ART) in the mid-1990s. Since then, death rates have continued to fall as treatment has gotten more effective and easier to take. Today, people who start treatment promptly can have a near-normal life expectancy. What’s more, the causes of death have evolved over time as the HIV population ages.

As described in The Lancet HIV, Adam Trickey, PhD, of the University of Bristol in the United Kingdom, and colleagues looked at longitudinal trends in cause-specific mortality among people with HIV in North America and Europe who started treatment between 1996 and 2020.

The analysis included more than 189,000 people ages 16 or older in 17 cohorts that contributed data to the Antiretroviral Therapy Cohort Collaboration. A total of 16,832 people (9%) died during the study period, and 13,180 deaths were retrospectively classified by cause.

Over the entire period, the most common causes of death were AIDS (25%), non-AIDS and non-liver-related cancers (14%) and cardiovascular or heart disease (8%). The all-cause mortality rate fell by half, from 16.8 deaths per 1,000 person-years during 1996-1999 to 7.9 per 1,000 during 2016-2020. The decline was steepest in the youngest age group (those ages 16 to 39).

The proportion of deaths due to AIDS declined dramatically, from 49% during 1996-1999 to 16% during 2016-2020.

The declines in cause-specific mortality were likely attributable in part to changes in treatment guidelines to recommend starting ART sooner, the availability of more effective and less toxic regimens and better care in general for people with HIV, the study authors suggested.

Mortality due to non-AIDS infections and accidents or suicide also declined. The only increases in mortality were due to central nervous system causes, respiratory illnesses and substance use. However, the latter can be difficult to classify due to overlaps with accidental overdose and suicide. Although the last follow-up date was April 2020, deaths due to COVID-19 are not mentioned.

“Although mortality among people with HIV on ART has decreased, there is still higher mortality among people with HIV than among the general population, due both to the consequences of HIV infection and to a higher prevalence of comorbidities and risk behaviors among people with HIV,” the authors concluded.

Published:January 24, 2024DOI: https://doi.org/10.1016/S2352-3018(23)00272-2