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Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration

Smith, CJ; Ryom, L; Weber, R; Morlat, P; Pradier, C; Reiss, P; Kowalska, JD; ... D:A:D Study Group, the; + view all (2014) Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet , 384 (9939) 241 - 248. 10.1016/S0140-6736(14)60604-8. Green open access

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Abstract

Background: Over time, an evolution in the causes of morbidity and mortality among HIV-positive individuals has been reported. It is increasingly important to monitor trends in causes of death to devise appropriate prevention and management strategies. Methods: Individuals from the D:A:D Study were followed from January 1999 until death, loss-to-follow-up or February 2011, whichever occurred first. Relative rates were calculated using Poisson regression. Results: There were 3,909 deaths in 49,731 individuals during 308,719 person-years (rate=12.7/1000 person-years; 95% CI 12.3-13.1). Leading underlying causes were: AIDS-related (28.7%), non-AIDS-defining cancers (15.1%), liver disease (13.2%) and cardiovascular disease (11.1%). Rates of all-cause death fell from 17.5/1000 person-years in 1999/2000 to 9.1 in 2009/2011; similar trends were seen in death rates for AIDS-related (5.9-2.0), liver disease (2.7-0.9) and cardiovascular disease (1.8-0.9). However, non-AIDS cancers death rates remained stable (1.6-2.1). Decreases in AIDS-related death rates were no longer evident after accounting for factors that changed over time, including CD4 cell count. However, all-cause, liver disease and cardiovascular disease death rates remained decreasing over time. The percentage of all deaths that were AIDS-related (34.0% in 1999/2000-22.5% in 2009/2011) and liver-related (15.6%-10.2%) decreased over time, whereas non-AIDS cancers increased (9.4%-22.7%). Conclusions: Recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 cell count. We hypothesize that the markedly reduced rates of liver disease and cardiovascular disease deaths over time could be explained by improved use of non-HIV specific preventive interventions. Non-AIDS cancer is now the leading non-AIDS cause and without any evidence of improvement. No other emerging trends in causes of unexpected deaths were observed.

Type: Article
Title: Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/S0140-6736(14)60604-8
Publisher version: http://dx.doi.org/10.1016/S0140-6736(14)60604-8
Language: English
UCL classification: 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 Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1434250
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