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Non-AIDS Non-Hepatitis Cancers Lead Causes of Death With HIV in Switzerland
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Time trends in causes of death in people with HIV: insights from the Swiss HIV Cohort Study.
EACS 2023, October 18-21, 2023, Warsaw
Mark Mascolini
From 2005 through 2022, non-AIDS non-hepatitis cancers emerged as the leading cause of death in the nationwide Swiss HIV Cohort Study (SHCS) [1]. Deaths from AIDS and liver-related causes dropped over that period, while median age at death jumped from 44 to 61.
This 18-year analysis benefits from plumbing an extensive longitudinal HIV database (the SHCS) in a single robust public health care system using the same reporting tool for illnesses and death. The longitudinal death analysis tried to nail down causes of death and cause-specific risk factors for people with HIV in the SHCS from 2005 through 2022. The investigators presented data on four overall causes of death: HIV/AIDS-related deaths, liver-related deaths including liver cancer, non-AIDS nonhepatic cancer deaths, and cardiovascular/heart-related deaths.
From 2005 through 2022, the SHCS team counted 1630 deaths in people with HIV, 24% of them assigned female at birth. These individuals had been living with HIV for a median 17 years. Over the study period median age at death leaped from 44 to 61 years, the proportion of people who inject drugs fell from 49% to 26%, and the proportion of men who have sex with men more than doubled from 19% to 40%.
The proportion of deaths attributed to HIV/AIDS dropped 5-fold over the study period (from 18.5% to 3.7%), while the proportion of liver-related deaths tumbled 7-fold (from 15.2% to 2.2%). The proportion of non-AIDS nonhepatic cancers doubled from 2005 through 2022, while the proportion of cardiovascular/heart-related deaths stayed flat.
The researchers counted 147 HIV/AIDS-related deaths. Much of the dwindling contribution of this category can be attributed to a halving of infection-related HIV/AIDS deaths. Within this category the proportion of deaths from AIDS cancers swelled dramatically from about 30% in 2005-2007 to about 75% in 2020-2022.
The waning contribution of liver disease to the overall death tally largely reflects the exceptional improvement in management of HCV infection. Throughout the study period 80% of all liver-related deaths happened in people with HCV infection.
The doubled proportion of non-AIDS nonhepatic cancers from 2005 through 2022 can be blamed mainly on lung cancers, which made up 35% of all cancers in this group, and pancreatic cancers, which accounted for 8% of the total.
The proportion of cardiovascular/heart-related deaths stayed fairly stable over time, even though cardiovascular risk profiles worsened in people with HIV. Although smoking became less frequent over the study years, hypertension and overweight/obesity became more prevalent. At the same time, SHCS investigators surmised that improving cardiovascular risk management in people with HIV contributed to the flat death trend over time. Ischemic heart diseases emerged as the most prevalent cause of death in this category, with cerebrovascular diseases in second place.
Reference
1. Weber MSR, Braun DL, Duran Ramiriz JJ, et al. Time trends in causes of death in people with HIV: insights from the Swiss HIV Cohort Study. EACS 2023, October 18-21, 2023, Warsaw. Abstract OS1.01.
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