Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study.
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.
Research Department of Infection and Population Health, UCL, Royal Free Campus, London, UK. c.smith@ucl.ac.uk
Smith
Colette
C
Sabin
Caroline A
CA
Lundgren
Jens D
JD
Thiebaut
Rodolphe
R
Weber
Rainer
R
Law
Matthew
M
Monforte
Antonella d'Arminio
Ad
Kirk
Ole
O
Friis-Moller
Nina
N
Phillips
Andrew
A
Reiss
Peter
P
El Sadr
Wafaa
W
Pradier
Christian
C
Worm
Signe W
SW
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