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Causes of Death among HIV-infected Adults in France in 2005 and Evolution since 2000
Charlotte Lewden*1,2, Charlotte Lewden*1,2, T May3, E Rosenthal4, C Burty3, F Bonnet1,5, F Bonnet1,5, D Costagliola6,7, D Costagliola6,7, E Jougla8, P Morlat1,2,5, P Morlat1,2,5, P Morlat1,2,5, D Salmon9, G Chêne1,2,5, G Chêne1,2,5, G Chêne1,2,5, and ANRS EN19 Mortalité 2005
1INSERM U593, Bordeaux, France; 2Univ Bordeaux 2, France; 3Hosp Brabois, Vandoeuvre-les-Nancy, France; 4Hosp L'Archet, Nice, France; 5Ctr Hosp Univ Bordeaux, France; 6INSERM U720, Hosp Pitie-Salpetriere, Paris, France; 7Univ Pierre and Marie Curie, Paris, France; 8INSERM, CépiDc, Le Vesinet, France; and 9Hosp Cochin-Tarnier, Paris, France
Background: Aging, long-term ART, and co-morbidities may
contribute to changing the causes of death among HIV-infected persons over
time. The Mortality 2005 survey aimed at describing the distribution of causes
of death among HIV-infected adults in France in 2005 and its evolution since
2000.
Methods: Physicians
involved in the management of HIV infection notified deaths that occurred in France in 2005.
The causes of death were documented using a standardized questionnaire similar
to the previous national survey
performed in 2000.
Results:
The 338 participating wards notified 967 deaths (964 in 2000) and
documented 823 cases until September 30, 2006. Median age was 46 years (41 in
2000); 75% were men; median known duration of HIV infection was 12 years (8 in
2000); the median last available CD4 cell count was 174/mm3 (94 in
2000). Overall, 30% of deceased patients were born abroad (25 in 2000) and 29%
were in poor socioeconomic conditions (33 in 2000). The main underlying causes
of death were: AIDS-related (38% vs 47% in 2000), cancer not related to AIDS or hepatitis
(16% vs 11%), liver-related (14% vs
13%; hepatitis C: 11% and hepatitis B: 2%), cardiovascular disease (9% vs 7%), other infections (5% vs
7%), and suicide (5% vs 4%). Among the 311 AIDS-related
deaths, the most frequent events were non-Hodgkin’s lymphoma (NHL) (31%). Among
cancers not related to AIDS or hepatitis, the most frequent localizations were
lung (31%) and digestive tract (17%); 5% were anal cancers; <1% of deaths
were directly related to an ART adverse effect. Patients who died of cancers
not related to AIDS or hepatitis and of cardiovascular disease were older.
Known duration of HIV infection was longer in patients who died of
liver-related cause; half of them had excessive alcohol consumption. Of
patients who died of non-AIDS related causes, >55% were smokers.
Conclusions:
AIDS-related deaths continue to decrease 10 years after the availability
of combination ART, but remain the most frequent cause of death, mainly due to
NHL. The proportion of deaths related to non-AIDS cancers, cardiovascular
diseases, and liver diseases is increasing and may be explained by aging,
co-morbidities, and at least 2 modifiable behaviors, namely, tobacco and
alcohol consumptions. In addition to HIV-specific care, case management of
HIV-infected persons should systematically include both prevention and early
detection of serious morbidity.
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