title: Causes of death in persons with human immunodeficiency virus infection.
abstract: OBJECTIVE
  Pneumocystis carinii pneumonia (PCP) was reported to be the predominant cause of human immunodeficiency virus (HIV)-related deaths prior to 1988, the year that effective prophylaxis against PCP entered routine use. Our study was performed to study the causes of HIV-related death since January 1988 in a region where patient tracking is virtually complete.
  
  
  METHODS
  We surveyed physicians associated with the Brown University Acquired Immunodeficiency Syndrome (AIDS) Program who cared for greater than 95% of known HIV-positive patients in Rhode Island. These physicians identified all those HIV-infected persons who had died under their care between January 1988 and July 1990, and determined these patients' causes of death by chart review. For comparison, death certificates of identified persons were also reviewed at the Rhode Island Department of Vital Statistics.
  
  
  RESULTS
  Among 126 deaths since January 1988, bacterial infections were the most common cause of death (30%), whereas PCP was responsible for only 16% of deaths. Persons not receiving any form of PCP prophylaxis were more likely to die from PCP than were those who received prophylaxis (26% versus 11% [p = 0.04]). Cause of death as recorded on actual death certificates was imprecise, although bacterial infections were again the most common cause indicated. Only one death occurred in a patient with a CD4 count greater than 200/mL, and this was not HIV-related.
  
  
  CONCLUSIONS
  PCP has not been the leading cause of death in our region since January 1988. Bacterial infections contribute substantially to mortality, and this may influence future prophylactic regimens. HIV-related deaths in patients with CD4 counts greater than 200/mL are unusual.
authors.affiliation: Department of Medicine, Brown University, Providence, Rhode Island.
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: P
authors.initials: P
authors.lastname: O'Sullivan
authors.forename: T
authors.initials: T
authors.lastname: Wachtel
authors.forename: A
authors.initials: A
authors.lastname: Fisher
authors.forename: D
authors.initials: D
authors.lastname: Mikolich
authors.forename: S
authors.initials: S
authors.lastname: Sepe
authors.forename: G
authors.initials: G
authors.lastname: Fort
authors.forename: C
authors.initials: C
authors.lastname: Carpenter
authors.forename: G
authors.initials: G
authors.lastname: Skowron
authors.forename: K
authors.initials: K
authors.lastname: Mayer
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality*; D000328:Adult; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012237:Rhode Island / Q000453:epidemiology