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Non-AIDS Deaths/Comorbidities Lead Causes of Death for PWH
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In total, 1630 deaths were reported, with 23.7% of individuals assigned female at birth. Out of these deaths, 147 (9.0%) were HIV/AIDS-related, 373 (22.9%) due to non-AIDS, non-hepatic (NANH) cancers, 166 (10.2%) liver-related, and 158 (9.7%) cardiovascular-related.
The advent of combination antiretroviral therapy (ART) in 1996 transformed the cause of death landscape, substantially reducing AIDS-related mortality in people with HIV (PWH), thus extending their life expectancy.[1-4] With successful virus suppression through ART, the cause of death profile of PWH shifted, witnessing a rise in non-AIDS-defining cancer deaths, liver-related conditions, and cardiovascular diseases. [1,3-5]
While HIV-related factors like late-stage diagnosis, delayed ART initiation, ART-related side effects, low-level replication, and inflammation play a role, non-HIV-related factors, such as sociodemographic and behavioral differences (e.g., higher rates of illicit drug use, smoking, and sexual behavior), also contribute significantly.[7-9] As a result, PWH experience higher rates of co-infections, including hepatitis C virus (HCV) and other oncogenic viruses, leading to higher rates of cardiovascular events and non-AIDS-defining cancers such as lung cancer. [1,7-14]
Abstract
Background
Advancements in access to antiretroviral therapy (ART) and human immunodeficiency virus (HIV) care have led to a decline in acquired immunodeficiency syndrome (AIDS)-related deaths among people with HIV (PWH) in Switzerland. However, data on the ongoing changes in causes of death among PWH over the past 15 years is scarce.
Methods
We investigated all reported deaths in the Swiss HIV Cohort Study between 2005-2022. Causes of death were categorized using the Coding Causes of Death in HIV protocol. The statistical analysis included demographic stratification to identify time trends and logistic regression models to determine associated factors for the underlying cause of death.
Results
In total, 1630 deaths were reported, with 23.7% of individuals assigned female at birth. Out of these deaths, 147 (9.0%) were HIV/AIDS-related, 373 (22.9%) due to non-AIDS, non-hepatic (NANH) cancers, 166 (10.2%) liver-related, and 158 (9.7%) cardiovascular-related.
The median age at death increased from 45.0 [40.0,53.0] years in 2005-2007 to 61.0 [56.0,69.5] years in 2020-2022. HIV/AIDS and liver-related causes of death decreased, whereas deaths from NANH cancers increased, and cardiovascular-related deaths remained relatively stable.
Conclusion
The proportionally decreasing HIV/AIDS and liver-related deaths showcase the effectiveness of ART, comprehensive HIV patient care, and interventions targeting hepatitis C virus co-infection. Future research should focus on managing cancer and cardiovascular-related conditions as the new leading causes of death among PWH. Comprehensive healthcare strategies focusing on non-AIDS-related comorbidities, cancer management, and sustaining liver and cardiovascular health are needed to bridge the ongoing health disparities between PWH and the general population.
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