Causes of death in the era of highly active antiretroviral therapy: a retrospective analysis of a hybrid hematology-oncology and HIV practice and the Seattle/King county adult/adolescent spectrum of HIV-related diseases project.
BACKGROUND
HIV-infected patients continue to die in the era of highly active antiretroviral therapy (HAART).


OBJECTIVE
To describe the cause of mortality in the HAART era between 2 cohorts by conducting a comparative retrospective analysis.


METHODS
The Virginia Mason Medical Center (VMMC) cohort was composed of 60 died HIV-infected patients from 600 patients. The second cohort was comprised of 351 died patients from the Seattle portion of the Adult and Adolescent Spectrum of Diseases Project (Seattle-ASD) of 4721 patients. Among the abstracted data were the conditions present at death, defined as any major cause of morbidity present at death for both cohorts.


RESULTS
Non-AIDS defining illnesses (non-ADI) were a major source of mortality in 60% and 45% for the VMMC and Seattle-ASD cohorts, respectively. The most common fatal non-ADI in both cohorts were cancer (7% and 19%), bacterial infections (15%), and liver failure (9% and 14%). Cancer (10%) and wasting (7%) were prominent fatal ADI in both cohorts. In each cohort, patients died despite a nondetectable HIV viral load and a CD4 lymphocyte count >200 cells/microL. This included 11 of 60 (18%) VMMC patients (all of whom died of non-ADI) and 35 of 351 (10%) Seattle-ASD patients (81% died with non-ADI).


CONCLUSIONS
In 2 well-characterized urban HIV cohorts, non-ADI were a major cause of mortality in the HAART era. A substantial number of these patients died despite nondetectable HIV viral loads and reasonably well-preserved immune function measured by CD4 cell counts.
Uhlenkott
Matthew C
MC
University of Washington School of Medicine, Seattle, Washington, USA.
Buskin
Susan E
SE
Kahle
Erin M
EM
Barash
Elizabeth
E
Aboulafia
David M
DM
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000150:complications / Q000401:mortality; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D019247:HIV Wasting Syndrome / Q000150:complications / Q000401:mortality; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications; D019562:Viral Load; D014861:Washington