Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy.
OBJECTIVE
To examine changes in the causes of death and mortality in women with human immunodeficiency virus (HIV) infection in the era of combination antiretroviral therapy.


METHODS
Among women with, or at risk of, HIV infection, who were enrolled in a national study from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates and the CD4 count. Poisson regression models were used to estimate death rates and to determine the risk factors for AIDS and non-AIDS deaths.


RESULTS
Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women, deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n = 29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16), non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or accident (n = 10). All-cause mortality declined an average of 26% per year (P = 0.03) and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related mortality remained stable (10% average annual decrease, P = 0.73). Factors that were independently associated with non-AIDS-related mortality included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age.


CONCLUSIONS
A substantial minority (20%) of deaths among women with HIV was due to causes other than AIDS. Our data suggest that to decrease mortality further among HIV-infected women, attention must be paid to treatable conditions, such as hepatitis C, depression, and drug and tobacco use.
Cohen
Mardge H
MH
Department of Medicine, Cook County Hospital, Chicago, Illinois, USA.
French
Audrey L
AL
Benning
Lorie
L
Kovacs
Andrea
A
Anastos
Kathryn
K
Young
Mary
M
Minkoff
Howard
H
Hessol
Nancy A
NA
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D016012:Poisson Distribution; D011336:Probability; D012307:Risk Factors; D012494:Sampling Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D019380:Anti-HIV Agents