The life span of persons with HIV has been greatly extended over the past 30 years due to novel therapies. In the developed world and urban settings, this results in a lifespan rivaling the lifespan of a person without HIV. A retrospective study was conducted on 459 patients of an urban, academic medical center who died between 2005 and 2013 in a medium-sized US city. Using the established Cause of Death Project (CoDe) protocol, we measured multiple factors including comorbidities, risk behaviours, contributing and underlying causes of death. This study is one of the few US-based studies using this validated protocol. Among the deaths, 25.9% were sudden and 15.2% were unexpected. Almost one-fifth were related to AIDS-related infections; 47.5% related to non-AIDS causes; with the remainder unknown. Statistically significant increases in CD4 counts and decreasing viral loads were observed over the study period. There were no statistically significant differences observed by HIV risk behaviour, race, gender, age at death, or on antiretrovirals at death. In support of the existing literature, improved HIV management appears to reduce the AIDS-related attributable death among patients observed in this study.
MocroftALedergerberBKatlamaC. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet2003; 362: 22–29.
2.
PalellaFJJr.DelaneyKMMoormanAC. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med1998; 338: 853–860.
3.
HarrisonKMSongRZhangX. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr2010; 53: 124–130.
4.
SamjiHCesconAHoggRS. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One2013; 8: e81355–e81355.
5.
CooperDA. Life and death in the cART era. Lancet2008; 372: 266–267.
6.
Antiretroviral Therapy Cohort C. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet2008; 372: 293–299.
7.
ZwahlenMHarrisR. Antiretroviral Therapy Cohort C. Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries. Int J Epidemiol2009; 38: 1624–1633.
8.
LohseNHansenABPedersenG. Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med2007; 146: 87–95.
9.
Antiretroviral Therapy Cohort C. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis2010; 50: 1387–1396.
10.
SmitCGeskusRWalkerS. Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion. AIDS2006; 20: 741–749.
11.
BraithwaiteRSJusticeACChangCC. Estimating the proportion of patients infected with HIV who will die of comorbid diseases. Am J Med2005; 118: 890–898.
12.
SmithCSabinCA. Data Collection on Adverse Events of Anti HIVdSG. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study. AIDS2010; 24: 1537–1548.
13.
OnenNFOvertonETSeyfriedW. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trial2010; 11: 100–109.
14.
CrothersKGouletJLRodriguez-BarradasMC. Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans. AIDS Educ Prev2009; 21: 40–53.
15.
GroupDADSFriis-MollerNReissP. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med2007; 356: 1723–1735.
16.
WandHCalmyACareyDL. Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection. AIDS2007; 21: 2445–2453.
17.
NeuhausJAngusBKowalskaJD. Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. AIDS2010; 24: 697–706.
18.
MocroftAReissPGasiorowskiJ. Serious fatal and nonfatal non-AIDS-defining illnesses in Europe. J Acquir Immune Defic Syndr2010; 55: 262–270.
19.
ParkerRDDykemaS. Differences in risk behaviors, care utilization, and comorbidities in homeless persons based on HIV status. J Assoc Nurses AIDS Care2014; 25: 214–223.
20.
ReifSSWhettenKWilsonER. HIV/AIDS in the Southern USA: a disproportionate epidemic. AIDS Care2014; 26: 351–359.
21.
Centers for Disease C, Prevention. Late versus early testing of HIV–16 Sites, United States, 2000–2003. MMWR Morb Mortal Wkly Rep2003; 52: 581–586.
22.
Centers for Disease C, Prevention. Late HIV testing – 34 states, 1996–2005. MMWR Morb Mortal Wkly Rep2009; 58: 661–665.
23.
Missed Opportunities for Earlier Diagnosis of HIV Infection – South Carolina, 1997–2005. Morbid Mortal Wkly Rep 2006; 55: 1269–1272.
24.
ReifSGolinCESmithSR. Barriers to accessing HIV/AIDS care in North Carolina: rural and urban differences. AIDS Care2005; 17: 558–565.
SuttonMAnthonyMNVilaC. HIV testing and HIV/AIDS treatment services in rural counties in 10 southern states: service provider perspectives. J Rural Health2010; 26: 240–247.
27.
WeisKELieseADHusseyJ. Associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis, South Carolina 2001–2005. J Rural Health2010; 26: 105–112.
RoystonPAltmanDG. Regression using fractional polynomials of continuous covariates – parsimonious parametric modeling. Appl Stat J Roy Soc C1994; 43: 429–467.
30.
SilkeBKellettJRooneyT. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling. QJM: Monthly Journal of the Association of Physicians2010; 103: 23–32.
31.
CaoSMoineddinRUrquiaML. J-shapedness: an often missed, often miscalculated relation: the example of weight and mortality. J Epidemiol Community Health2014; 68: 683–690.
32.
Centers for Disease Control and Prevention. CDC Slide Set. HIV Surveillance in Urban and Nonurban Areas (through 2011). Available at: http://www.cdc.gov/hiv/library/slideSets/ (accessed 29 January 2015).
33.
BrozDWejnertCPhamHT. HIV infection and risk, prevention, and testing behaviors among injecting drug users – National HIV Behavioral Surveillance System, 20 U.S. Cities, 2009. MMWR Surveill Summ2014; 63: 1–51.
34.
MeditzALMaWhinneySAllshouseA. Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis2011; 203: 442–451.
35.
OurslerKKGouletJLLeafDA. Association of comorbidity with physical disability in older HIV-infected adults. Aids Patient Care STDS2006; 20: 782–791.
36.
KimHMSmithEGStanoCM. Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Serv Res2012; 12: 18–18.
37.
NotaroSJKhanMKimC. Analysis of the health status of the homeless clients utilizing a free clinic. J Commun Health2012; 25: 25–25.
38.
KowalskaJDFriis-MollerNKirkO. The coding causes of death in HIV (CoDe) Project: initial results and evaluation of methodology. Epidemiology2011; 22: 516–523.
