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The Changing Spectrum of HIV Mortality: Analysis of 249 Deaths from 1995-1999 T. CHOWDHRY*, H. VALDEZ, R. ASAAD, I. WOOLLEY, T. DAVIS, R. DAVIDSON, and M. M. LEDERMAN.
Univ. Hosp. of Cleveland, Case Western Reserve Univ., Cleveland, OH
Background and Methods: Mortality among HIV infected patients
has been decreasing with the advent of HAART. In our HIV clinic
that has maintained a stable patient population of between 600 and 650
patients, we analyzed the 249 deaths that occurred from January 1995-June
1999. Cause of death, CD4 cell count, viral load, and medications at time
of death were obtained through review of the clinic database,
chart review, death certificates, coroner’s reports, and primary doctors’
input.
Results: Deaths had fallen progressively from 115 in 1995, to 20
in 1998 but increased to 21 in the first 6 months of 1999.
OEO=other end organ failure
UVL=undetectable viral load (Percentage of all tested)
The frequency of OIs as a cause of death fell dramatically from 33 (28%
of deaths) in 1995 to 4 (20%) in 1998. The proportion of deaths
due to end organ failure rose from 20% in 1995 to >50% in 1999. The median
last CD4 count before death rose progressively from 1995 to 1999 (p<0.01)
and approximately 20-25% of patients dying between 1997 and 1999 were
under good virologic control.
Conclusions: Though mortality has fallen progressively from 1995
to 1998, there is a recent trend to an increase in death rates in our
large HIV clinic. Though a greater proportion of recent deaths is due
to end-organ failure, the decrease in the number of these deaths suggests
that "end-organ failures" are often terminal complications of AIDS. Deaths
are occurring in persons with greater levels of immune capacity as reflected
in CD4 cell counts and also in persons under good virologic control. These
observations underscore the need both to monitor the etiologies of HIV-associated
mortality and to better understand the relationship between immune defenses,
treatment-related toxicities and end organ failure in HIV disease.
Key Words: death, mortality, organ failure
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