title: Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study.
abstract: OBJECTIVE
  To investigate any emerging trends in causes of death amongst HIV-positive individuals in the current cART era, and to investigate the factors associated with each specific cause of death.
  
  
  METHODS
  An observational multicentre cohort study.
  
  
  METHODS
  All HIV-positive individuals included in one of the cohorts in the Data Collection on Adverse Events of Anti-HIV drugs (D:A:D) Study were included. The association between HIV-specific and non HIV-specific risk factors and death were studied using multivariable Poisson regression.
  
  
  RESULTS
  We observed 2482 deaths in 180,176 person-years (PY) on 33,308 individuals [rate/1000 PY = 13.8 (95% CI 13.2-14.3)]. Primary causes of death were: AIDS (n = 743; rate/1000 PY = 4.12), liver-related (341; 1.89), CVD-related (289; 1.60), non-AIDS malignancy (286; 1.59). The overall rate of death fell from 16.9 in 1999/2000 to 9.6/ 1000 PY in 2007/2008. Smoking was associated with CVD and non-AIDS cancers, HBV and HCV co-infection with liver-related deaths, and hypertension with liver-related and CVD deaths. Diabetes was a risk factor for all specific causes of death except non-AIDS cancers, and higher current HIV RNA for AIDS-related deaths. Lower CD4 cell counts were associated with a higher risk of death from all specific causes of death.
  
  
  CONCLUSIONS
  Multiple potentially modifiable traditional and HIV-specific risk factors for death of HIV-infected persons were identified. The maximum reduction in mortality in HIV-infected populations will require that each of these factors be appropriately addressed. No trends in terms of emerging causes of unexpected deaths were observed, although monitoring will continue.
authors.affiliation: Research Department of Infection and Population Health, UCL, Royal Free Campus, London, UK. c.smith@ucl.ac.uk
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiebaut
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Nina
authors.initials: N
authors.lastname: Friis-Moller
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Wafaa
authors.initials: W
authors.lastname: El Sadr
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.forename: Signe W
authors.initials: SW
authors.lastname: Worm
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality*; D001315:Australia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000821:virology; D002423:Cause of Death / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000821:virology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology