Causes of Death among Persons with AIDS in the Era of Highly Active Antiretroviral Therapy: New York City

  1. Judith E. Sackoff, PhD;
  2. David B. Hanna, MS;
  3. Melissa R. Pfeiffer, MPH; and
  4. Lucia V. Torian, PhD
  1. From the New York City Department of Health and Mental Hygiene, New York, New York.

    Abstract

    Background: Monitoring the full spectrum of causes of death among persons with AIDS is increasingly important as survival improves because of highly active antiretroviral therapy.

    Objective: To describe recent trends in deaths due to HIV-related and non–HIV-related causes among persons with AIDS, identify factors associated with these deaths, and identify leading causes of non–HIV-related deaths.

    Design: Population-based cohort analysis.

    Setting: New York City.

    Patients: All adults (age ≥13 years) living with AIDS between 1999 and 2004 who were reported to the New York City HIV/AIDS Reporting System and Vital Statistics Registry through 2004 (n = 68 669).

    Measurements: Underlying cause of death on the death certificate.

    Results: Between 1999 and 2004, the percentage of deaths due to non–HIV-related causes increased by 32.8% (from 19.8% to 26.3%; P = 0.015). The age-adjusted mortality rate decreased by 49.6 deaths per 10 000 persons with AIDS (P < 0.001) annually for HIV-related causes but only by 7.5 deaths per 10 000 persons with AIDS (P = 0.004) annually for non–HIV-related causes. Of deaths due to non–HIV-related causes, 76% could be attributed to substance abuse, cardiovascular disease, or a non–AIDS-defining type of cancer. Compared with men who have sex with men, injection drug users had a statistically significantly increased risk for death due to HIV-related causes (hazard ratio, 1.59 [95% CI, 1.49 to 1.70]) and non–HIV-related causes (hazard ratio, 2.54 [CI, 2.24 to 2.87]).

    Limitations: Compared with autopsy and chart review, death certificates may lack specificity in the underlying cause of death or detailed clinical and treatment-related information.

    Conclusions: Non–HIV-related causes of death account for one fourth of all deaths of persons with AIDS. Cardiovascular disease, non–AIDS-defining cancer, and substance abuse account for most non–HIV-related deaths. Reducing deaths from these causes requires a shift in the health care model for persons with AIDS from a primary focus on managing HIV infection to providing care that addresses all aspects of physical and mental health.

    Article and Author Information

    • Acknowledgments: The authors thank Richard Selik, MD, Centers for Disease Control and Prevention HIV Incidence and Case Surveillance Branch, for careful review of the manuscript; the field surveillance and data support staff, especially Sonny Ly and Walter Smith, New York City DOHMH HIV Epidemiology Program, for assistance with case reviews and data management; and the New York City DOHMH Office of Vital Statistics for sharing data and expertise.

    • Grant Support: Through a cooperative agreement between the New York City DOHMH HIV Epidemiology Program and the Centers for Disease Control and Prevention (U62/CCU223595).

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Judith E. Sackoff, PhD, HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 346 Broadway, Room 706, CN44, New York, NY 10013; e-mail, jsackoff{at}health.nyc.gov.

    • Current Author Addresses: Drs. Sackoff and Torian, Mr. Hanna, and Ms. Pfeiffer: HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 346 Broadway, Room 706, CN44, New York, NY 10013.

    • Author Contributions: Conception and design: J.E. Sackoff, D.B. Hanna, M.R. Pfeiffer, L.V. Torian.

    • Analysis and interpretation of the data: J.E. Sackoff, D.B. Hanna, M.R. Pfeiffer, L.V. Torian.

    • Drafting of the article: J.E. Sackoff, D.B. Hanna.

    • Critical revision of the article for important intellectual content: J.E. Sackoff, D.B. Hanna, M.R. Pfeiffer, L.V. Torian.

    • Final approval of the article: J.E. Sackoff, D.B. Hanna, M.R. Pfeiffer, L.V. Torian.

    • Statistical expertise: D.B. Hanna.

    • Obtaining of funding: J.E. Sackoff.

    • Administrative, technical, or logistic support: J.E. Sackoff, D.B. Hanna, M.R. Pfeiffer.

    • Collection and assembly of data: D.B. Hanna, M.R. Pfeiffer.

    Responses to this article

    • Letter to Editor
      • Adrian M. Di Bisceglie and
      • Karen L. Lindsay M.D., Margaret J. Koziel M.D., David L. Thomas M.D., Robert L. Murphy5M.D., Marion G. Peters M.D.,
      Ann Intern Med published online October 26, 2009

    Summary for Patients

    • Summaries for Patients:Causes of Death in People with AIDS in New York City between 1999 and 2004 Ann Intern Med September 19, 2006 145:I-49
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