title: All-cause mortality in hospitalized HIV-infected patients at an acute tertiary care hospital with a comprehensive outpatient HIV care program in New York City in the era of highly active antiretroviral therapy (HAART).
abstract: OBJECTIVE
  The overall mortality rate among human immunodeficiency virus (HIV)-infected patients has significantly declined in the era of highly active antiretroviral therapy (HAART). However, little is known about the causes of death for HIV-infected patients who are hospitalized in acute care hospitals.
  
  
  METHODS
  A retrospective chart review of hospitalized HIV-infected patients from 2004 to 2008 was undertaken.
  
  
  RESULTS
  Among 9,101 hospitalized HIV-infected patients, 237 deaths were identified, with an overall mortality rate of 237/9,101 (2.6 %). The mortality rate did not differ from year to year (2-3 %). Charts for 208 patients were available for review and were analyzed. The following medians were noted: age 49 years, CD4+ T cell count 137 cells/μL, HIV viral load (VL) log10 3.93, length of stay 16 days. The proportion of men were 71.6 %, African Americans (AAs) were 62.5 %, and HAART use was 52.4 %, with an overall good adherence rate of only 17.3 %. The major causes of death were non-acquired immunodeficiency syndrome (AIDS)-related illness (81.7 %, 170/208): sepsis (34.6 %, 72/208), non-recurrent bacterial pneumonia (19.7 %, 41/208), cardiac disease (5.8 %, 12/208), liver disease (4.3 %, 9/208), and non-AIDS-related malignancy (4.3 %, 9/208). The major causes of death due to AIDS-related illness (18.3 %, 38/208) were: Pneumocystis jirovecii pneumonia (4.8 %, 10/208) and AIDS-related encephalopathy, including progressive multifocal leukoencephalopathy/cryptococcal meningitis/cerebral toxoplasmosis (3.4 %, 7/208). Mortality due to AIDS-related illnesses was associated with younger age (median age 44 vs. 50 years, p = 0.001), female sex (44.7 vs. 24.7 %, p = 0.013), and lower CD4+ T cell counts (median 10 vs. 66, p = 0.001).
  
  
  CONCLUSIONS
  The mortality rate in our hospitalized HIV-infected patients remained low. Non-AIDS-related illnesses were the major causes of death, with sepsis being the most common. Low CD4+ T cell count and female sex were associated with deaths due to AIDS-related illness. Poor adherence to HAART was also noted in those patients to whom treatment was offered in the outpatient setting. Further prospective studies are needed in order to better define the epidemiology and outcomes for hospitalized HIV-infected patients in the era of HAART.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: G
authors.initials: G
authors.lastname: Psevdos
authors.forename: E
authors.initials: E
authors.lastname: Gonzalez
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: M C
authors.initials: MC
authors.lastname: Kilayko
authors.forename: V
authors.initials: V
authors.lastname: Sharp
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D012737:Sex Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*