Featured Research

from universities, journals, and other organizations

Causes of death shifting in people with HIV

Date:
July 17, 2014
Source:
The Lancet
Summary:
HIV-positive adults in high income countries face a substantially reduced risk of death from AIDS-related causes, cardiovascular disease, and liver disease compared with a decade ago, according to a large international study. Although deaths from most causes declined over the study period, there was no reduction in death rates from non-AIDS cancers which remained stable over time (1.6 deaths per 1000 years 1999-2000 to 2.1 in 2009-2011). Non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV, accounting for 23% of all deaths.

HIV-positive adults in high income countries face a substantially reduced risk of death from AIDS-related causes, cardiovascular disease, and liver disease compared with a decade ago, according to a large international study published in The Lancet.

Related Articles


The study which involved nearly 50,000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe, USA, and Australia found that overall death rates have almost halved since 1999, while deaths due to AIDS-related causes and cardiovascular disease have declined by around 65% and liver-related deaths by more than 50%.

Although deaths from most causes declined over the study period, there was no reduction in death rates from non-AIDS cancers which remained stable over time (1.6 deaths per 1000 years 1999-2000 to 2.1 in 2009-2011). Non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV, accounting for 23% of all deaths.

Using data from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study, the researchers looked at trends in underlying causes of death in people with HIV between 1999 and 2011, who were followed-up for a median of 6 years.

Of the 3909 deaths that occurred over the study period, around 29% of individuals died from an AIDS-related cause, which remains the most common cause of death. Cancers (15%; mainly lung cancer) were the most frequent causes of non-AIDS deaths, followed by liver disease (13%; mainly due to hepatitis), and cardiovascular disease (11%).

Mortality decreased from about 17.5 deaths per 1000 person-years in 1999-2000 to 9.1 deaths per 1000 years in 2009-2011 -- a drop of around 50%. Similar decreases in deaths related to AIDS (5.9 deaths per 1000 person-years to 2.0), liver disease (2.7 to 0.9), and cardiovascular disease (1.8 to 0.9) were also seen. The proportion of all deaths due to AIDS (34% to 23%) and liver disease (16% to 10%) declined over the decade, while the proportion of deaths due to cardiovascular disease remained constant at 10%.

The researchers note that substantially reduced death rates from liver and cardiovascular disease cannot be fully explained by changes in patient demographics or improvements in viral suppression or CD4 count, and might result from the better management of traditional risk factors such as smoking, alcohol use, and hepatitis, or the use of less toxic ART regimens.

They conclude by calling for further research to gain a clearer understanding of why the risk of dying from a non-AIDS cancer remains high and to assess the effect of specific antiretroviral drugs on non-AIDS cancer rates.

According to study leader Dr Colette Smith from University College London in the UK, "These recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count and provide further evidence of the substantial net benefits of ART. But despite these positive results, AIDS-related disease remains the leading cause of death in this population. Continued efforts to ensure good ART adherence and to diagnose more individuals at an earlier stage before the development of severe immunodeficiency are important to ensure that the low death rate from AIDS is sustained and potentially decreased even further."

Writing in a linked Comment, Steven Deeks and Peter Hunt from the University of California in San Francisco, USA, say, "The benefits of ART are unquestioned, and their beneficial effect on the HIV epidemic continues to grow. Still, clear limitations exist because many patients are not accessing treatment, and some problems persist even in those on ART, including a higher than expected risk of non-AIDS cancers and other morbidities. Finally, it needs to be emphasised that we are still early in the ART era. In the absence of a cure, most patients will need to continue on ART for decades. Continued monitoring for unexpected consequences of treatment will be needed indefinitely."

The study appears in a special issue of The Lancet published ahead of AIDS 2014, the 20th international AIDS conference of the IAS, taking place in Melbourne, Australia, from 20-25 July, 2014.


Story Source:

The above story is based on materials provided by The Lancet. Note: Materials may be edited for content and length.


Journal Reference:

  1. Colette J Smith, Lene Ryom, Rainer Weber, Philippe Morlat, Christian Pradier, Peter Reiss, Justyna D Kowalska, Stephane de Wit, Matthew Law, Wafaa el Sadr, Ole Kirk, Nina Friis-Moller, Antonella d'Arminio Monforte, Andrew N Phillips, Caroline A Sabin, Jens D Lundgren. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. The Lancet, 2014; 384 (9939): 241 DOI: 10.1016/S0140-6736(14)60604-8

Cite This Page:

The Lancet. "Causes of death shifting in people with HIV." ScienceDaily. ScienceDaily, 17 July 2014. <www.sciencedaily.com/releases/2014/07/140717212144.htm>.
The Lancet. (2014, July 17). Causes of death shifting in people with HIV. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2014/07/140717212144.htm
The Lancet. "Causes of death shifting in people with HIV." ScienceDaily. www.sciencedaily.com/releases/2014/07/140717212144.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com
Flu Outbreak Closing Schools in Ohio

Flu Outbreak Closing Schools in Ohio

AP (Dec. 17, 2014) A wave of flu illnesses has forced some Ohio schools to shut down over the past week. State officials confirmed one pediatric flu-related death, a 15-year-old girl in southern Ohio. (Dec. 17) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins