Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers.
OBJECTIVE
To describe the characteristics of deaths that occur among HIV-positive individuals in the HAART era.


METHODS
Observational database.


METHODS
Deaths were reviewed that occurred among HIV-positive individuals seen at the Royal Free Hospital, London between January 1998 and December 2003.


RESULTS
Over the study period, there were 121 deaths; death rates declined from approximately 2.0/100 person-years of follow-up in 1998-2000 to approximately 1.0/100 person-years of follow-up in 2001-2003. Approximately one half of deaths (45.5%) were from AIDS-related causes and 74 deaths (61.2%) occurred in individuals who had received HAART: patients had been exposed to a median of seven (range 2-14) antiretroviral drugs and two-fifths had started treatment in the pre-HAART era. Another 15 patients had received only non-HAART treatment regimens prior to death. The median pre-death CD4 cell counts were 68 and 167 cells/microl among those who had and had not received HAART; 23 (31.1%) and 4 (8.5%) had HIV RNA < 400 copies/ml, respectively. Of the patients exposed to HAART for at least 6 months and who experienced viral rebound, information was available on resistance for 26 (21.5% of the total deaths) and 19 of those tested had at least one resistance mutation (median 5, range, 1-16).


CONCLUSIONS
While mortality rates among HIV-infected individuals at our centre have fallen since 1988, the deaths that do now occur are more diverse and are the result of a number of factors, including late presentation, delayed uptake of HAART and the previous use of treatment combinations that are now viewed as suboptimal.
Sabin
Caroline A
CA
Department of Primary Care and Population Sciences, Royal Free and UC Medical School, Pond St, London, UK. c.sabin@pcps.ucl.ac.uk
Smith
Colette J
CJ
Youle
Mike
M
Lampe
Fiona C
FC
Bell
Di Robertson
DR
Puradiredja
Dewi
D
Lipman
Marc C I
MC
Bhagani
Sanjay
S
Phillips
Andrew N
AN
Johnson
Margaret A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000235:genetics / Q000401:mortality*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000235:genetics / Q000401:mortality; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors
D044966:Anti-Retroviral Agents; D015415:Biomarkers; D012367:RNA, Viral