299   Causes of Death Among HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy (HAART). Aquitaine Cohort (France), 1998—1999.

F. Bonnet¹, P. Morlat*¹, G. Chene*², P. Mercie³, D. Neau⁴, I. Chossat⁴, M. Decoin², C. Lewden², D. Malvy¹, J. L. Pellegrin³, J. M. Ragnaud⁴, M. Dupon⁴, F. Dabis², J. Beylot¹, and the GECSA.
¹Hosp. Saint-André;²INSERM U330, CHU, Bordeaux;³Hosp. Haut-Lévèque, and⁴Hosp. Pellegrin, France.

Background:A marked decline in mortality has occurred among HIV-infected patients since the introduction of HAART. The precise causes of death in the current era need to be better defined.

Methods:We studied causes of death in 1998 and 1999 among adult patients followed at the Bordeaux University Hospital within the Aquitaine Cohort. All data were collected by the same physician, after review of the hospital medical records and interview of the deceased patients' attending physicians.

Results:Among a cohort of 2200 patients, 65 deaths occurred in 1998 and 40 in 1999 (annual mortality rate of 3.0 and 1.8%, respectively). 83 medical records have been investigated so far. 76% of patients were male. Median age at time of death was 43 years (range 18—68). Median CD4⁺was 167/mm³(range 1—790). Morbidity recorded at the time of death was hepatitis C (14) or B (1) cirrhosis, non-Hodgkin lymphoma (NHL) (11), CNS diseases (11), non-HIV-related malignancy (11), bacterial pneumonia or pulmonary infection of unknown etiology (8), cytomegalovirus infection (8), mycobacterial infection (7), myocardiopathy (6), pulmonary hypertension (5), toxoplasmosis (3), cryptococcosis (3), pneumocystosis (1) or leishmaniosis (1). Causes of death were AIDS-defining event (n = 37, 45%) (including 10 NHL), non-AIDS/HIV-related infections (n = 7, 8%), hepatitis C (n = 11, 13%), cardiovascular event (n = 9, 11%), non-HIV-related malignancy (n = 9, 11%), suicide (n = 4, 5%), hepatitis B (n = 2, 2%), traffic accident (n = 1, 1%), and drug-related (n = 3, 4%).

Conclusions:Non-AIDS-related events seem to have become the major causes of death of HIV-infected patients in the era of HAART. The high proportions of NHL (27%) among AIDS-related causes of death, of others malignancies (20%), and hepatitis (30%) among non-AIDS related causes are noteworthy. This assessment of the causes of death in the era of HAART justifies an adaptation of the epidemiological and clinical surveillance of HIV-infected patients.