title: Impact of HAART on causes of death of persons with late-stage AIDS.
abstract: BACKGROUND
  The increasing use of highly active antiretroviral therapies (HAARTs) has changed the course of AIDS-related illnesses and enhanced the quality of life of patients infected with human immunodeficiency virus (HIV) and may have changed the causes of deaths in patients with acquired immunodeficiency syndrome (AIDS).
  
  
  OBJECTIVE
  The aim of the present study was to investigate causes of deaths in long-term care hospital patients with late-stage AIDS who expired at the Coler-Goldwater Memorial Hospital in New York City in 1995, and in 1998 and 1999, that is, immediately before and the two most recent years after the advent of HAART.
  
  
  METHODS
  Analysis of causes of deaths as recorded on the death certificates of 232 AIDS patients.
  
  
  RESULTS
  The overall mortality rate declined from 75.6 deaths per 100 person-years in 1995 to 33.2 deaths per 100 person-years in 1998-1999 (P < .001). The number of AIDS patients who expired because of sepsis and opportunistic infections, which included Pneumocystis carinii pneumonia (PCP), decreased significantly from 30 (26.1%) and 24 (20.9%) in 1995 to 15 (12.8%) and 10 (8.5%) in 1998-1999, respectively (P < .05). In contrast, deaths from hepatic failure increased from 0 (0%) in 1995 to 7 (6%) in 1998-1999 (P < .05). Increases, although not significant statistically, were associated with pneumonias excluding PCP, end-stage AIDS, renal failure, and malignancies. Analysis of cause-specific mortality by gender between 1995 and 1998-1999 revealed very little difference between men and women. This analysis showed, however, that the infectious processes taken together (pneumonias excluding PCP, sepsis, and opportunistic infections including PCP) were significantly less frequent causes of death in 1998-1999 than in 1995 (P < .01).
  
  
  CONCLUSIONS
  These findings indicate that HAART affected the causes of deaths in patients with AIDS, with "traditional" opportunistic infections diminishing in importance relative to chronic medical conditions and malignancies.
authors.affiliation: Coler-Goldwater Memorial Hospital, Roosevelt Island, New York, NY 10044, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Sansone
authors.forename: J D
authors.initials: JD
authors.lastname: Frengley
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D017093:Liver Failure; D008297:Male; D009519:New York City / Q000453:epidemiology; D018805:Sepsis
chemical_list: D019380:Anti-HIV Agents