Epidemiology

Attention to noninfectious perimortal conditions in HIV patients needed

Last Updated: 2007-11-23 7:58:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Since the introduction of highly active antiretroviral therapy (HAART) in the United States, there has been a downward trend in many infectious perimortal diseases but an upward trend in noninfectious perimortal conditions, according to results of a study.

Dr. Dina Hooshyar from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues investigated trends in perimortal conditions, defined as pathological conditions causing death or present at death but not necessarily the reported cause of death, during three time periods: 1992-1995 (pre-HAART); 1996-1999 (early HAART); and 2000-2003 (contemporary HAART). Data came from the Adult/Adolescent Spectrum of HIV Disease project.

Among a total of 9,225 deaths, 58.6% occurred in the pre-HAART period, 29.5% in the early HAART period, and 11.9% in the modern HAART era, they report in the October 1 issue of AIDS.

Death rates fell from 487.5 per 1,000 person-years in 1995 to 100.6 per 1,000 person-years in 2002.

Linear trends in proportionate mortality for AIDS-defining infectious diseases (e.g., pneumocystosis, nontuberculous mycobacterial disease, and cytomegalovirus disease) decreased significantly, while proportionate mortality for noninfectious diseases (e.g., liver disease, hypertension, and alcohol abuse) increased significantly over the time periods.

"Further investigation is needed," Dr. Hooshyar and colleagues conclude, "to determine the causes of the increase in proportionate mortality for several noninfectious perimortal diseases in a population with many prevalent comorbidities (e.g., psychiatric disorders, substance use, and alcohol abuse), which could interfere with the effectiveness of HAART."

The data also "support screening and treatment for these (noninfectious) conditions in order to sustain the trend in declining mortality rates."

AIDS 2007;21:2093-2100.