AIDS-related causes of death among adults with HIV have more than halved in 10 years, a study out today has revealed.
A large international study published in The Lancet has found that out of almost 50,000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe, USA, and Australia, overall death rates have almost halved since 1999.
Deaths due to AIDS-related causes and cardiovascular disease have declined by about 65%, while liver-related deaths have dropped by more than 50%.
However, over the study period there was no reduction in death rates from non-AIDS cancers, which remained stable over time at 1.6 deaths per 1,000 years 1999-2000 to 2.1 in 2009–2011).
The research is published in a special issue of The Lancet published ahead of AIDS 2014, the international AIDS conference of the IAS, in Melbourne, Australia, and reveals that non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV, accounting for 23% of all deaths.
Using data from the Data Collection On Adverse Events Of Anti-HIV Drugs (D:A:D) study, researchers from University College London, England, examined trends in underlying causes of death in people with HIV between 1999 and 2011, who were followed-up for a median of 6 years.
Of the 3,909 deaths that occurred over the study period, about 29% were from an AIDS-related cause. Cancers at 15% – mainly lung cancer – were the most frequent causes of non-AIDS deaths, followed by liver disease at 13% and then and cardiovascular disease (11%).
Mortality decreased from about 17.5 deaths per 1,000 person-years in 1999-2000 to 9.1 deaths per 1,000 years in 2009-2011.
There were similar falls in deaths related to AIDS (5.9 deaths per 1,000 person-years to 2.0), liver disease (2.7 to 0.9), and cardiovascular disease (1.8 to 0.9).
Study leader Dr Colette Smith said: “These recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count and provide further evidence of the substantial net benefits of ART.
“But despite these positive results, AIDS-related disease remains the leading cause of death in this population.
“Continued efforts to ensure good ART adherence and to diagnose more individuals at an earlier stage before the development of severe immunodeficiency are important to ensure that the low death rate from AIDS is sustained and potentially decreased even further.”
Further research is needed to gain a clearer understanding of why the risk of dying from a non-AIDS cancer remains high and to assess the effect of specific antiretroviral drugs on non-AIDS cancer rates, she added.
Smith C J, Ryom L et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. The Lancet. 2014; 384: 241–48. [abstract]
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