title: Causes of death and factors associated with early death among human immunodeficiency virus (HIV)-infected persons in Singapore: pre-highly active antiretroviral therapy (HAART) and Peri-HAART.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has greatly changed the epidemiology of human immunodefi ciency virus (HIV) mortality. The aim of this study is to compare the causes of death and factors associated with early death in HIV-infected persons in the pre- and peri-highly active antiretroviral therapy (HAART) periods.
  
  
  METHODS
  We conducted a retrospective review of 483 HIV-infected persons who were diagnosed with HIV from 1985 to 2000, and had died within 5 years of the diagnosis. We examined the temporal change in the primary causes of death between those who were diagnosed in the pre-HAART (1985 to 1995) and peri-HAART (1996 to 2000) periods, and compared the demographic and clinical characteristics of the 2 groups.
  
  
  RESULTS
  During the peri-HAART period, HIV encephalopathy, cryptococcal meningitis, and lymphoma were no longer the leading causes of death. Opportunistic infections remained important causes of death. Early deaths from the peri-HAART period were older (60 years and above) at diagnosis (Adj OR 7.50; 95% CI, 1.78 to 31.58), more likely to be divorced (Adj OR 5.05, 95% CI, 1.96 to 13.02) and tended to have a low baseline CD4 cell count of <50 cells/ uL (Adj OR 2.18, 95% CI, 1.14 to 4.16) , and were more likely to have received HAART (Adj OR 5.19; 95% CI, 2.22 to 12.12) than early deaths from the pre-HAART period.
  
  
  CONCLUSIONS
  In the peri-HAART era, HIV-infected persons who died within 5 years of diagnosis were those who were older (≥60 years), divorced, or who presented with very late-stage disease (CD4 <50) at diagnosis. More targeted public health interventions, such as targeted public health messages and outreach to increase access to HIV testing and treatment should be developed for these subpopulations.
authors.affiliation: Department of Clinical Epidemiology, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore. Angela_Chow@ttsh.com.sg
authors.forename: Angela
authors.initials: A
authors.lastname: Chow
authors.forename: Jeannie
authors.initials: J
authors.lastname: Tey
authors.forename: Mar Kyaw
authors.initials: MK
authors.lastname: Win
authors.forename: Yee Sin
authors.initials: YS
authors.lastname: Leo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002423:Cause of Death / Q000639:trends*; D016001:Confidence Intervals; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D016017:Odds Ratio; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents