SOEDAK2009 --- PREPARE FOR THE LONG RUN

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Titel
Mortality of HIV-infected patients in the HAART era
Autor
Mario Sarcletti1, Margret Jöchl2, Stefanie Gogl3, Armin Rieger4, Maria Geit5, Bernhard Haas6, Robert Zangerle1
Abstract
Objective: To describe the characteristics of deaths that occur among HIV-positive individuals in the HAART era.
Methods: Observational database. Deaths were reviewed that occurred among HIV-positive individuals seen at 4 Austrian HIV treatment centres. between January 1997 and December 2007. Patients with loss of follow up were checked with death registry data.
Results: Overall 480 deaths occurred during the study period (17676,6 patient-years). During the study period the mortality rate decreased from 3,1 deaths/100 person-years (d/py) in 1997 to 2,4 d/py in 2002 and 2,5 d/py in 2007, respectively.

[Causes of death in HAART era]
In parallel, HIV-associated causes of death decreased (1997, 2002 and 2007: 2,1, 1,1 and 1,1 d/py, respectively). A slight decrease in Hepatitis B/Hepatitis C-associated death rate was observed (1997, 2002 and 2007: 0,4, 0,4 and 0,2 d/py, respectively), whereas the death rate caused by non-AIDS defining tumours increased during study period (1997, 2002 and 2007: 0,2, 0,2 and 0,5 d/py, respectively). Decreasing death rates were striking in patients of younger age (< 34 years: 1997, 2002 and 2007: 10,3, 4,3 and 1,6 d/py, respectively, whereas an increase was observed in older patients (>45 years: 1997, 2002 and 2007: 1,3, 1,4 and 3,0 d/py, respectively).

[Mortality among age groups]
The mortality rate for women was 2,4 d/py in 1997, 1,8 d/py in 2002 and 2,0 d/py in 2007, for injecting drug user the rate was 8,8 d/py, 8,4 d/py and 8,1d/py, respectively. The CD4 count increased from 120 cells/µl in 1997 to 215 cells/µl in 2007.
Conclusions: HIV-associated mortality has decreased after introduction of HAART. At time of death patients have higher CD4 counts and were of higher age. The spectrum of mortality has changed with HAART, with more deaths due to tumours and myocardial infarction. Women had a lower mortality rate. Exposure to HIV through injection drug use was associated with a higher mortality risk.
Datei SOEDAK_09_OSA2.pdf