Journal of Urban Health

, Volume 77, Issue 2, pp 166–175

Impact of haart on causes of death of persons with late-stage AIDS

  • Giorgio R. Sansone
  • J. Dermot Frengley
Original Articles: HIV and Long-Term Care

Abstract

Context

The increasing use of highly active antiretroviral therapies (HAARTs) has changed the course of AIDS-related illnesses and enhanced the quality of life of patients infected with human immunodeficiency virus (HIV) and may have changes the causes of deaths in patients with acquired immunodeficiency syndrome (AIDS).

Objective

The aim of the present study was to investigate causes of deaths in long-term care hospital patients with late-stage AIDS who expired at the Coler-Goldwater Memorial Hospital in New York City in 1995, and in 1998 and 1999, that is, immediately before and the two most recent years after the advent of HAART.

Methods

Analysis of causes of deaths as recorded on the death certificates of 232 AIDS patients.

Results

The overall mortality rate declined from 75.6 deaths per 100 person-years in 1995 to 33.2 deaths per 100 person-years in 1998–1999 (P<.001) The number of AIDS patients who expired because of sepsis and opportunistic infections, which includedPneumocystis carinii Pneumonia (PCP), decreased significantly from 30 (26.1%) and 24 (20.9%) in 1995 to 15 (12.8%) and 10 (8.5%) in 1998–1999, respectively (P<.05). In contrast, deaths from hepatic failure increased from 0(0%) in 1995 to 7 (6%) in 1998–1999 (P<.05). Increases, although not significant statistically, were associated with pneumonias excluding PCP, end-stage AIDS, renal failure, and malignancies. Analysis of cause-specific mortality by gender between 1995 and 1998–1999 revealed very little difference between men and women. This analysis showed, however, that the infectious processes taken together (pneumonias excluding PCP, sepsis, and opportunistic infections including PCP) were significantly less frequent causes of death in 1998–1999 than in 1995 (P<.01).

Conclusion

These findings indicate that HAART affected the causes of deaths in patients with AIDS, with “traditional” opportunistic infections diminishing in importance relative to chronic medical conditions and malignancies.

Key Words

Death HAART Hepatic Failure Late-Stage AIDS Opportunistic Infections Sepsis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brettle RP, Wilson A, Povey S, et al. Combination therapy for HIV; the effect on inpatient activity, morbidity and mortality of a cohort of patients.Int J STD AIDS. 1998;9:80–87CrossRefPubMedGoogle Scholar
  2. 2.
    Hogg RS, Heath KC, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretrovira therapy.JAMA 1998;11:450–454.Google Scholar
  3. 3.
    Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection.N Engl J Med. 1998; 338:853–860.CrossRefPubMedGoogle Scholar
  4. 4.
    Chiasson MA, Berenson L, Li W, et al. Declining AIDS mortality in New York City.J. Acquir Immune Defic Syndr Hum Retrovirol 1998;21:59–64.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention.HIV/AIDS Surveillance Report. Estimated Incidence of AIDS and Deaths of Persons with AIDS, Adjusted for Delays in Reporting, by Quarter-Year of Diagnosis/Death. United States. January 1985-June 1997. Atlanta, GA: Centers for Disease Control and Prevention; 1997;9:1–44.Google Scholar
  6. 6.
    Chaisson RE, Moore RD. Prevention of opportunistic infections in the era of improved antiretroviral therapy.J. Acquir Immune Defic Syndr Hum Retrovirol. 1997;16(suppl 1): S14-S22.PubMedGoogle Scholar
  7. 7.
    Bartlett JA, Benoit SL, Johnson VA, et al.. Lamivudine plus zidovudine compared with zalcitabine plus zidovudine in patients with HIV infection: a randomized, doubleblind, placebo-controlled trial.Ann Intern Med. 1996;125:161–172.PubMedGoogle Scholar
  8. 8.
    Hammer SM, Katzenstein DA, Hughes MD, et al. A trial comparing nucleoside monotherapy with combination therapy in HIV-infected adults with CD4 cell counts from 200 to 500 per cubic milliter.N Engl J Med. 1996;335:1081–1090.CrossRefPubMedGoogle Scholar
  9. 9.
    Katzenstein DA, Hammer SM, Hughes MD, et al. The relation of virologic and immunologic markers to clinical outcomes after nucleoside therapy in HIV-infected adults with 200 to 500 CD4 cells per cubic milliliter.N Engl J Med. 1996;335:1091–1098.CrossRefPubMedGoogle Scholar
  10. 10.
    Gulick R, Mellors J, Havlir D, et al. Treatment with indinavir, zidovudine and lamivudine in adults with human immunodeficiency virus infection and prior antinetroviral therapy.N. Engl J Med. 1997;337:734–739.CrossRefPubMedGoogle Scholar
  11. 11.
    Brodt RH, Kamps BS, Gute P, et al. Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy.AIDS. 1997;11:1731–1738.CrossRefPubMedGoogle Scholar
  12. 12.
    Jacobson MA, French M. Altered natural history of AIDS-related opportunistic infections in the era of potent combination antiretroviral therapy.AIDS. 1998;12(suppl A): S157-S163PubMedGoogle Scholar
  13. 13.
    Macdonald JC, Torriani FJ, Morse LS, et al. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy.J Infect Dis. 1998;177:1182–1187.PubMedGoogle Scholar
  14. 14.
    Schneider MM, Borleffs JC, Stolk RP, et al. Discontinuation of prophylaxis forPneumocystis carinii pneumonia in HIV-1 infected patients treated with highly active antiretroviral therapy.Lancet. 1999;353:201–203.CrossRefPubMedGoogle Scholar
  15. 15.
    Pezzotti P, Dal Maso L, Serraino D, et al. Has the spectrum of AIDS-defining illnesses been changing since the introduction of new treatments and combination of treatments?J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20:515–516.PubMedGoogle Scholar
  16. 16.
    Stein M, O'Sullivan P, Wachtel T, et al. Causes of death in persons with human immunodeficiency virus infection.Am J Med. 1992;93:387–390.CrossRefPubMedGoogle Scholar
  17. 17.
    Kravcik S, Hawley-Foss N, Victor G, et al. Causes of death of HIV-infected persons in Ottawa, Ontario, 1984–1995.Arch Intern Med. 1997;157:2069–2073.CrossRefPubMedGoogle Scholar
  18. 18.
    Selik RM, Chu SY, Ward JW. Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992.Ann Intern Med. 1995; 125:933–936.Google Scholar
  19. 19.
    Centers for Disease Control. 1993 Revised classification system for HIV infection and expanded surveillance definition for AIDS among adolescents and adults.NMWR Morb Mortal Wkly Rep. 1992;41:1–19.Google Scholar
  20. 20.
    Glantz SA, Primer of biostatistics, New York: McGraw-Hill, Health Professions Division; 1992.Google Scholar
  21. 21.
    Katz MH, Hessol NA, Buchbinder SP, et al. Temporal trends of opportunistic infections and malignancies in homosexual men with AIDS.J Infect Dis. 1994;170:198–202.PubMedGoogle Scholar
  22. 22.
    Dore GJ, Hoy JF, Mallal SA, et al. Trends in incidence of AIDS illnesses in Australia 1983–1994: the Australian AIDS cohort.J. Acquir Immune Defic Syndr. 1997;16:39–43.Google Scholar
  23. 23.
    Rosenberg HM. Improving cause-of-death statistics.Am J Public Health. 1989;79:563–564.PubMedGoogle Scholar
  24. 24.
    Metz SA, Hutchins GM, Bacellar H, et al. A comparison of autopsy and death certificates findings among AIDS-related deaths in the Multicenter AIDS Cohort Study.Int Conf AIDS. 1993;9:659.Google Scholar
  25. 25.
    Bigger RJ, Rabkin CS. The epidemiology of AIDS-related neoplasms.Hematol Oncol Clin North Am. 1996;10:997–1010.Google Scholar
  26. 26.
    Remick SC. Non-AIDS-defining cancers.Hematol Oncol Clin North Am. 1996;10:1203–1213.CrossRefPubMedGoogle Scholar
  27. 27.
    Wistuba II, Behrens C, Gazdar AF. Pathogenesis of non-AIDS-defining cancers: a review.AIDS Pat Care STDs. 1999;13:415–426.Google Scholar
  28. 28.
    Garcia-Milian R, Hermandez H, Panade L, et al. Detection and typing of human papillomavirus DNA in benign and malignant tumors of laryngeal epithelium.Acta OtoLaryngol. 1998;118:754–758.PubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2000

Authors and Affiliations

  • Giorgio R. Sansone
    • 1
  • J. Dermot Frengley
    • 1
  1. 1.Coler-Goldwater Memorial Hospital
  2. 2.Administrative Offices-E1Coler-Goldwater Memorial HospitalNY

Personalised recommendations