16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

TRENDS IN MORTALITY AND CAUSES OF DEATH AMONG HIV-INFECTED INDIVIDUALS DIAGNOSED IN THE UK: 1993 – 2004

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0202

Ciancio B.C.¹, Forde J.², Dougan S.², Chadborn T.², Delpech V.^2
1 Health Protection Agency/Centre for Infection/European Programme for Intervention Epidemiology (EPIET), HIV & STI department, London, United Kingdom, ² Health Protection Agency/Centre for Infection, HIV & STI department, London, United Kingdom

BACKGROUND: Since HAART introduction, the number of HIV-infected individuals dying in the UK has declined to approximately 450 deaths per annum. We describe the epidemiology and causes of death among HIV-infected individuals between 1993 and 2004.

METHODS: We analysed surveillance data on HIV-infected adults (≥15 years), died in the UK between 1993 and 2004. The period 1997 – 2004 was defined as the HAART era. An AIDS-related death was defined as a death due to an AIDS defining illness. Late HIV diagnosis was defined as a CD4 count <200/mm³ at diagnosis.

RESULTS: Cause of death was available for 8976 (96%) of deaths, of which, 3597 (38%) during the HAART era. Comparing deaths occurred before and after HAART availability, an increase has been observed in the proportion of deaths due to PCP (6% vs 11%), non-Hodgkin's Lymphoma (NHL) (5% vs 9%), cardiovascular (5% vs 8%) and liver disease (3% vs 7%). The majority of AIDS-related deaths (77%) in the HAART era were late diagnoses. The proportion of MSM declined from 70% to 46%, conversely the proportion of black Africans heterosexuals increased from 7% to 21%. During the HAART era Black African heterosexuals died at a younger median age (37 vs 41.5) and more frequently of AIDS-related causes (52% vs 41%), compared with MSM.

(2002 – 2004), the commonest causes of death among black African heterosexuals were: pneumonia (16%), PCP (14%), TB (13%) and cardiovascular disease (8%); and among MSM: pneumonia (18%), cardiovascular disease (12%), NHL (10%), PCP (9%) and liver disease (7.5%).

In addition, 80% of black African heterosexuals who died during the HAART era had been diagnosed late compared with 54% of MSM.

CONCLUSIONS: Early diagnosis and treatment could prevent some AIDS-related deaths, particularly among black African heterosexuals. For MSM public health intervention should also consider the prevention of deaths due to cardiovascular and hepatic disease.

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2006-08-13
ThAc0202

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