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Non-AIDS Deaths 80% of All deaths for PWH >60: Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: a collaboration of cohort studies
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You can clearly see in Figure 1 that Non-AIDS deaths comprise most of the deaths for PWH, particularly for PWH > 60 years old, and cancers, liver disease & CVD are leading causes of death in older PWH. In NYC the leading cause of death among PWH is CVD followed by cancer and COVID in recent years. And Non-HIV-related deaths are 4 times greater than HIV-related reflecting the same finding that comorbidities are the leading causes of death for older PWH. Jules
There was a large reduction in the proportion of AIDS-related mortality, from 49% during 1996-99 to 16% during 2016-20, with increases in the proportion of mortality due to cancers from 5% during 1996-99 to 19% during 2016-20 (figure 1). There was a reduction in the proportion of AIDS-related deaths over calendar time for all age groups (figure 2): the proportion of AIDS-related deaths was lowest for the oldest age group who, correspondingly, had the highest proportions of cardiovascular or heart-related and cancer-related mortality. People with HIV with the highest CD4 counts experienced larger average declines in rates of all-cause mortality than those with lower CD4 counts. Declines in rates of all-cause mortality over calendar time were larger among people with HIV with no previous AIDS-defining events than for those with previous AIDS-defining events, with similar patterns observed for most causes of death.
The trends in cause-specific mortality captured here should assist policy makers in targeting improvements in the care of people with HIV towards conditions that are amenable to interventions and have the biggest influence on mortality. The per-period reductions in cause-specific mortality for people with HIV on ART are probably partly due to changes in treatment guidelines meaning that people start ART sooner after diagnosis, as well as more effective and less toxic regimens becoming available, and better care in general for people with HIV. Although mortality among people with HIV on ART has decreased, there is still higher mortality among people with HIV than among the general population, due both to the consequences of HIV infection and to a higher prevalence of comorbidities and risk behaviours among people with HIV.
Although there were reductions in rates of non-AIDS-related mortality, such as cancer and cardiovascular disease, non-AIDS deaths make up an increasingly large proportion of mortality among people with HIV. Expanding access to prevention, screening, and treatment of these conditions is required to close the gap of comorbidity prevalence between adults with and those without HIV, and funders should recognise this.
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