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Cause of death among HIV patients in London in 2016

Croxford, S; Miller, RF; Post, FA; Harding, R; Lucas, SB; Figueroa, J; Harrison, I; ... Sullivan, AK; + view all (2019) Cause of death among HIV patients in London in 2016. HIV Medicine 10.1111/hiv.12761. (In press). Green open access

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Abstract

Objectives: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. / Methods: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. / Results: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non‐AIDS‐related malignancies and AIDS‐defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non‐injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty‐nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/μL, and 24% had a viral load ≥ 200 HIV‐1 RNA copies/mL. Thirty‐six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two‐thirds of expected deaths had a prior end‐of‐life care discussion documented. / Conclusions: In 2016, most deaths were attributable to non‐AIDS‐related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.

Type: Article
Title: Cause of death among HIV patients in London in 2016
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/hiv.12761
Publisher version: https://doi.org/10.1111/hiv.12761
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: cause of death, HIV, London, mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10078624
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