THAB0304 - Oral Abstract
Trends over time in underlying causes of death in the D:A:D study from 1999 to 2011
Presented by Colette Smith (United Kingdom).
R. Weber1, C. Smith2, D:A:D Study Group
1University Hospital, Zurich, Switzerland, 2UCL, Infection and Population Health, London, United Kingdom
Background: HIV+ individuals in care with access to ART may experience a wider range of non-AIDS-related complications than previously. It is important to accurately classify causes of death, and monitor trends over time.
Methods: Individuals from a large prospective cohort collaboration (D:A:D) were followed starting from 1999 until death, loss-to-follow-up or February 2011, whichever came first. Underlying causes of death were attributed based on the Coding of causes of Death (CoDe) system
Results: 3,802 deaths occurred in 49,734 individuals followed for 304,695 person-years (rate=12.5/1000 person-years [95% CI 12.1-12.9]). Leading underlying causes were: AIDS-related (29%), non-AIDS-defining malignancies (NADM; 14%), liver disease (LD; 13%), cardiovascular disease (CVD; 11%), invasive bacterial infection (7%), drug overdose (3%), accidents (2%), renal disease (1%) and unknown (7%). Decreases over time occurred in rates of all-cause (17.4/1000 person-years in 1999-2000 to 8.3 in 2009-2011), AIDS-related (5.9-1.9), LD (2.7-0.8) and CVD-related (1.8-0.8) mortality. However, the rate of NADM deaths remained stable (1.5-1.6). After accounting for factors including current CD4 count (Table), there was still evidence of decreases over time in LD and CVD deaths, but not AIDS-related. The proportion of all deaths attributed to AIDS (34% in 1999-2000 to 22% in 2009-2011), NADM (9%-20%) and LD (16%-9%) changed over time.
Conclusions: Underlying causes of death have changed markedly over the last 12 years. AIDS remains the leading cause. Although there have been marked reductions over time in AIDS-related deaths, this effect is removed when accounting for current CD4 and other factors. NADMs are now the leading non-AIDS cause. Rates of LD and CVD-related deaths have decreased substantially, even after accounting for the factors listed below, suggesting other improvements in patient management during the study period. No trends in emerging causes of unexpected deaths were observed. Collection of specific causes of deaths is important to allow earlier interventions in HIV case management.
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