title: A standardized algorithm for determining the underlying cause of death in HIV infection as AIDS or non-AIDS related: results from the EuroSIDA study.
abstract: OBJECTIVE
  Analyzing changes in causes of death over time is essential for understanding the emerging trends in HIV population mortality, yet data on cause of death are often missing. This poses analytic limitations, as does the changing approach in data collection by longitudinal studies, which are a natural consequence of an increased awareness and knowledge in the field. To monitor and analyze changes in mortality over time, we have explored this issue within the EuroSIDA study and propose a standardized protocol unifying data collected and allowing for classification of all deaths as AIDS or non-AIDS related, including events with missing cause of death.
  
  
  METHODS
  Several classifications of the underlying cause of death as AIDS or non-AIDS related within the EuroSIDA study were compared: central classification (CC-reference group) based on an externally standardised method (the CoDe procedures), local cohort classification (LCC) as reported by the site investigator, and 4 algorithms (ALG) created based on survival times after specific AIDS events.
  
  
  RESULTS
  A total of 2,783 deaths occurred, 540 CoDe forms were collected, and 488 were used to evaluate agreements. The agreement between CC and LCC was substantial (κ = 0.7) and the agreement between CC and ALG was moderate (κ < 0.6). Consequently, a stepwise algorithm was derived prioritizing CC over LCC and, in patients with no information available, best-fit ALG. Using this algorithm, 1,332 (47.9%) deaths were classified as AIDS and 1,451 (52.1%) as non-AIDS related.
  
  
  CONCLUSIONS
  Our proposed stepwise algorithm for classifying deaths provides a valuable tool for future research, however validation in another setting is warranted.
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark. jko@cphiv.dk
authors.forename: Justyna D
authors.initials: JD
authors.lastname: Kowalska
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.forename: Eric
authors.initials: E
authors.lastname: Florence
authors.forename: Matti
authors.initials: M
authors.lastname: Ristola
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
authors.forename: Helen
authors.initials: H
authors.lastname: Sambatakou
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000465:Algorithms; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D015497:HIV-1; D006801:Humans; D011446:Prospective Studies