Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City.
BACKGROUND
Monitoring the full spectrum of causes of death among persons with AIDS is increasingly important as survival improves because of highly active antiretroviral therapy.


OBJECTIVE
To describe recent trends in deaths due to HIV-related and non-HIV-related causes among persons with AIDS, identify factors associated with these deaths, and identify leading causes of non-HIV-related deaths.


METHODS
Population-based cohort analysis.


METHODS
New York City.


METHODS
All adults (age > or =13 years) living with AIDS between 1999 and 2004 who were reported to the New York City HIV/AIDS Reporting System and Vital Statistics Registry through 2004 (n = 68,669).


METHODS
Underlying cause of death on the death certificate.


RESULTS
Between 1999 and 2004, the percentage of deaths due to non-HIV-related causes increased by 32.8% (from 19.8% to 26.3%; P = 0.015). The age-adjusted mortality rate decreased by 49.6 deaths per 10,000 persons with AIDS (P < 0.001) annually for HIV-related causes but only by 7.5 deaths per 10 000 persons with AIDS (P = 0.004) annually for non-HIV-related causes. Of deaths due to non-HIV-related causes, 76% could be attributed to substance abuse, cardiovascular disease, or a non-AIDS-defining type of cancer. Compared with men who have sex with men, injection drug users had a statistically significantly increased risk for death due to HIV-related causes (hazard ratio, 1.59 [95% CI, 1.49 to 1.70]) and non-HIV-related causes (hazard ratio, 2.54 [CI, 2.24 to 2.87]).


CONCLUSIONS
Compared with autopsy and chart review, death certificates may lack specificity in the underlying cause of death or detailed clinical and treatment-related information.


CONCLUSIONS
Non-HIV-related causes of death account for one fourth of all deaths of persons with AIDS. Cardiovascular disease, non-AIDS-defining cancer, and substance abuse account for most non-HIV-related deaths. Reducing deaths from these causes requires a shift in the health care model for persons with AIDS from a primary focus on managing HIV infection to providing care that addresses all aspects of physical and mental health.
Sackoff
Judith E
JE
HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York 10013, USA. jsackoff@health.nyc.gov
Hanna
David B
DB
Pfeiffer
Melissa R
MR
Torian
Lucia V
LV
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003644:Death Certificates; D005260:Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality; D009519:New York City / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000401:mortality