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Session 120 Poster Abstracts
Morbidity and Mortality of HIV-1 Infection
Monday, 1:30 - 3:30 pm
Poster Hall


872
Mortality and Morbidity in the HAART Era: Changing Causes of Death and Disease in the HIV Outpatient Study
F J Palella Jr*1, R Baker2, A C Moorman3, J Chmiel1, K Wood2, S D Holmberg3, and the HOPS Investigators
1Northwestern Univ., Chicago, IL, USA; 2Cerner Corp., Herndon, VA, USA; and 3CDC, Atlanta, GA, USA

Background:  Our objective was to describe trends in mortality and morbidity among HIV-infected patients in the era of HAART.

Methods:  We analyzed data from 5561 participants in the HOPS who were treated at 2 public, 4 university, and 2 private clinics from January 1, 1996 to December 31, 2002, using HOPS data updated as of June 30, 2003. We calculated rates of death, opportunistic diseases, and other non-opportunistic illnesses determined to be primary or secondary causes of death by category of disease, e.g., pulmonary, hepatic, renal. We also evaluated CD4 cell counts/mm3 (CD4) and time spent on ART. 

Results:  For 5561 patients followed a median of 35.3 months, death rates fell from 6.3 deaths/100 person-years of observation in 1996 to 2.2 deaths/100 person-years in 2002 (p = 0.03 for trend). Death rates stabilized to approximately 2 deaths/100 person-years after 1998. Opportunistic disease rates fell similarly and remained low:  23/100 person-years in 1996 to 8/100 person-years in 2000, with further decline to 6/100 person-years in 2002 (p = 0.0039 for trend). HAART use rates in this cohort rose from 48% in 1996 to 8O% in 2002. Of 473 deaths included in this analysis, the proportion of all primary and secondary causes of deaths that were non-opportunistic illnesses increased over time from 45.7% in 1996 to 71.7% in 2002 (p <0.0001 for trend). The proportion of all causes of death that were non-opportunistic illnesses increased with the time patients were on ART (54.5% when patients on ART for 2 years vs 70.2% when patients on ART for ≥7 years), (p = 0.0012 for trend). Mean CD4 closest to death (within 6 months, n = 342 deaths) increased over time from 65.5 cells in 1996 to 148.4 cells in 2002 (p = 0.017 for trend). For the calendar years 2000, 2001, and 2002, the most frequent non-opportunistic illnesses cited as contributing to death, as a percentage of all deaths in this 3-year period were:  hepatic (35.6%); pulmonary (22.7%); cardiovascular (17.2%); renal (9.8%).  

Conclusions:  While overall death and OI rates remained low through the seventh year of highly prevalent HAART usage in the HOPS, the proportion of deaths attributable to non-opportunistic illness increased and was positively associated with the number of years having received ART. Likewise, over time, an increasing proportion of observed deaths occurred at higher CD4 cell count values.

Keywords: Mortality; Morbidity; HAART