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Leading Causes of Death in HIV....liver disease, AIDS, heart disease, malignancies
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don't forget to protect those CD4 cells
12th CROI Feb 2005
Reported for NATAP by David Margolis, MD
Univ of Texas, Southwestern Medical Center Dallas; VA Dallas; ACTG
Among the rows of posters, a piquant lesson from the D:A:D study group stood out (abstr. 595). As you recall, this prospective study of 23,441 patients from 11 existing cohorts in Europe, Australia, and the United States explored the relationships of HIV infection, HAART and cardiovascular disease. As detailed information on death occurring between the initiation of D:A:D in 2000 and February 2004 was collected, the group presented an analysis of causes of death.
Death in people with HIV infection is often classified according to whether they are "HIV-related" or not. Of the 23,441 persons in D:A:D, 82% had used ART prior to enrollment (median exposure 2.8 years). Over the study period, 1248 (5.3%) patients died (incidence: 1.6 deaths/100 person-years). The leading cause of death was AIDS (30%) followed by liver-related death (14%, of which 79% were associated with chronic viral hepatitis), death from heart disease (including cardiovascular disease, 9%), and death from non-AIDS malignancies (8%). The proportion of deaths from these causes remained stable over time. AIDS-related death was, as expected, strongly associated with the latest CD4 cell count (relative rates of death from an AIDS-event in patients with latest CD4 count < 50 cells/µL vs > 500 cells/µL after adjustment for HIV RNA, age, cohort, race; 96.4 [95% CI 61.6 to 150.7], p < 0.0001).
Strikingly, however, liver-related deaths (relative rate 26.6 [12.9 to 54.7], p < 0.0001) and deaths from non-AIDS malignancies (23.5 [9.4 to 58.7], p < 0.0001) were similarly strongly associated with latest CD4 count; the relationship with death from heart disease was less strong but remained significant (3.1 [1.2 to 8.2], p = 0.02). Therefore, it appears that all causes of death in the HIV-infected are related, to some extent, to HIV infection. Death from causes generally referred to as non-HIV-related is more likely to occur in persons with lower rather than higher CD4 counts.
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