753-W. Causes of Death in HIV-Infected Adults in the Era of Highly Active Antiretroviral Therapy (HAART), the French Survey "Mortalite 2000"

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Session 99 Poster Session
Predictors and Causes of Mortality in HIV Disease
Session Time: 4:30-6:30 pm
Room 4E-F

753-W.

Causes of Death in HIV-Infected Adults in the Era of Highly Active Antiretroviral Therapy (HAART), the French Survey "Mortalite 2000"
C. Lewden*¹, L. Héripret², F. Bonnet³, S. Bévilacqua⁴, E. Jougla⁵, J. Boileau⁵, D. Costagliola⁶, P. Morlat³, T. May⁴, D. Salmon², and G. Chêne¹ for the "Mortalité 2000" Study Group
¹INSERM U330, Bordeaux; ²CHU-Cochin, Paris; ³CHU, Bordeaux; ⁴CHU, Nancy; ⁵INSERM CépiDC, Le Vésinet; and ⁶INSERM SC4, Paris, France

Background: Although the use of HAART has dramatically decreased the mortality in HIV-infected patients, the mortality remains higher in this population than in the general population. Moreover, causes of death have changed over time. The aim of the French prospective survey "Mortalité 2000" was to describe the causes of death of HIV-1-infected adults in France in 2000.
Methods: All hospital wards known to be involved in the case management of HIV infection were contacted during the first trimester of 2000. The causes of death were documented using a standardized questionnaire by each of the 188 participating wards representing a total of around 62,000 HIV-infected patients followed.
Results: From January to June 2000, 535 deaths were notified, and data of 422 deceased patients was available for analysis. 79% were men and median age was 41 years (10%-90% range 33-60). The HIV transmission category was sex with men in 29%, injecting drug use in 29%, heterosexual contact in 29%. Alcohol excessive consumption was reported in 25% of patients and smoking in 51%. HIV seropositivity had been known for 8 years in median (interquartile range 3-12). The closest measure of CD4+ cell count was >=50/mm³ in 62% of patients and >=200/mm³ in 29%; HIV-RNA was <500 copies/mL in 30%. 15% of patients were still naïve of antiretroviral therapy and 27% had not reached the clinical AIDS stage. Death was related to at least one AIDS-defining illness in 51% of patients. Among the 371 AIDS-defining illnesses notified in these 217 patients, the most frequent were: wasting syndrome (n=51), non-Hodgkin’s lymphoma (NHL) (n=50), cytomegalovirus disease (CMV) (n=47), Pneumocystis carinii pneumonia (PCP) (n=30), atypical mycobacteria infection (n=30), brain toxoplasmosis (n=28), Kaposi’s sarcoma (n=27), tuberculosis (n=20). The most frequent non AIDS-related causes of death were: hepatitis C infection (HCV) (10% of all deaths), non-AIDS-defining cancer (9%), cardio-vascular disease (7%), non-AIDS-defining infection (7%), suicide (4%), accident or intoxication (3%), unknown (3%), drug side effect (1%).
Conclusions: In 2000, half of death cases in HIV-infected patients were AIDS-related. Cancers like NHL and opportunistic infections like CMV disease, PCP, mycobacteries, and toxoplamosis remain of particular importance and should still be recognised, treated, or prevented. Non-AIDS-related cases are quite diversified and should be considered with particular attention.