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Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort

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Abstract

Objective

We aimed to examine the clinical outcome in HIV-1-infected patients after more than 10 years of highly active antiretroviral therapy (HAART).

Methods

We analyzed data from 1,236 treatment-naïve adults who had started HAART. The primary endpoint was the yearly prevalence of death for AIDS-related causes (ARC) or for non-AIDS related causes (non-ARC). The data from our cohort were compared with that of the general population (GP) of our region.

Results

We observed that 116 patients died, and 58.6% of deaths were non-ARC. The death incidence decreased from 18.8% in 1998–1999 to 1.2% in 2008–2009. The leading causes of death were malignancies (35.3%), infections (21.6%), end-stage liver diseases (18.1%), and cardiovascular diseases (CVD) (6.9%). Yearly death rates were similar in the HIV-infected cohort and in the crude GP (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.5–2.5), but when adjusted for age, HIV-infected patients showed a greater risk (OR 7.4, 95% CI 4.1–13.4). The difference was still highly significant when the analysis was restricted to non-ARCs (OR 4.3, 95% CI 2.07–9.2). Overall, malignancies (OR 5.7, 95% CI 2.6–12.8) and end-stage liver diseases (OR 35.0, 95% CI 15.5–78.8) were significantly more frequent than in the age-adjusted GP.

Conclusions

Despite HAART, HIV-infected patients are at greater risk of death compared to a reference uninfected population.

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Conflict of interest

F.S. has served as a consultant on advisory boards for Bristol-Myers Squibb and Roche; he has also served as a speaker for GlaxoSmithKline, Roche, and Boehringer Ingelheim, and has received research and educational grants from Bristol-Myers Squibb, Gilead, Boehringer Ingelheim, GlaxoSmithKline, Jansen-Cilag, and Roche. F.M. has served as a consultant on advisory boards for Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Roche, and Tibotec; he has received lecture fees from Abbott, Bayer, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck Sharp and Dome, and Roche, and has received research and educational grants from Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Jansen-Cilag, and Roche.

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Authors and Affiliations

  1. Division of Infectious Diseases, Ospedali Riuniti, Largo Barozzi 1, 24128, Bergamo, Italy

    S. Leone, G. Gregis, G. Quinzan, D. Velenti, G. Cologni, L. Soavi, V. Ravasio, D. Ripamonti, F. Suter & F. Maggiolo

  2. Unit of Antiviral Therapy, Ospedali Riuniti, Bergamo, Italy

    S. Leone, G. Gregis, G. Quinzan, D. Velenti, G. Cologni, L. Soavi, D. Ripamonti & F. Maggiolo

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  1. S. Leone
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  2. G. Gregis
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  3. G. Quinzan
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  4. D. Velenti
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  5. G. Cologni
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  6. L. Soavi
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  7. V. Ravasio
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  8. D. Ripamonti
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  9. F. Suter
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  10. F. Maggiolo
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Corresponding authors

Correspondence to S. Leone or F. Maggiolo.

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Leone, S., Gregis, G., Quinzan, G. et al. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection 39, 13–20 (2011). https://doi.org/10.1007/s15010-010-0079-z

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  • DOI: https://doi.org/10.1007/s15010-010-0079-z

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