Effects of HIV infection on age and cause of death for persons with hemophilia A in the United States.
Because of changes in factor replacement therapy and in treatment of human immunodeficiency virus (HIV) infection, we examined death record data for persons with hemophilia A in the United States to evaluate effects of HIV infection on age and causes of death. Multiple cause-of-death data from 1968 through 1998 were examined to assess death rates for persons with hemophilia A. ICD-9 coded causes of death from 1979 through 1998 were examined to assess long-term trends. From 1979 through 1998, 4,781 deaths among persons with hemophilia A were reported, of which 2,254 (47%) had HIV-related disease listed as a cause of death. In the late 1980s, mortality among persons with hemophilia A increased markedly, and the age-adjusted death rate peaked at 1.5 per 1,000,000 population in 1992. Median age at death decreased from 55 years in 1979-1982 to 40.5 years in 1987-1990, and increased to 46 years in 1995-1998. In the period 1995-1998, the median age of hemophilia A decedents with HIV-related disease was 33 years, compared to 72 years for those without HIV-related disease; the most frequently listed causes of death for those without HIV-related disease were hemorrhagic and circulatory phenomena; the most frequently listed for those with HIV-related disease were diseases of liver and the respiratory system. From 1995 to 1998, hemophilia A-associated deaths decreased by 41%, with a 78% decrease among those who had HIV-related disease. Although HIV infection has adversely effected mortality for persons with hemophilia A, the marked recent decrease in the death rate among persons with hemophilia A appears to reflect advances in care for those with HIV-related disease and is consistent with a decline in HIV mortality observed in the general population.
Chorba
T L
TL
Division of Immunologic, Oncologic, and Hematologic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, Atlanta, Georgia, USA. tlc2@cdc.gov
Holman
R C
RC
Clarke
M J
MJ
Evatt
B L
BL
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003644:Death Certificates; D003953:Diagnosis-Related Groups; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006467:Hemophilia A / Q000150:complications / Q000401:mortality*; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006525:Hepatitis, Viral, Human / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D044469:Racial Groups; D012120:Respiration Disorders / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000998:Antiviral Agents