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RESEARCH ARTICLE

Risk factors and causes of death in the Australian HIV Observational Database

Kathy Petoumenos A C , Matthew G. Law A and on behalf of the Australian HIV Observational Database B
+ Author Affiliations
- Author Affiliations

A National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria Street, Darlinghurst, NSW 2010, Australia.

B Contributors to the Australian HIV Observational Database are listed in the appendix.

C Corresponding author. Email: kpetoumenos@nchecr.unsw.edu.au

Sexual Health 3(2) 103-112 https://doi.org/10.1071/SH05045
Submitted: 21 September 2005  Accepted: 24 February 2006   Published: 26 May 2006

Abstract

Introduction: Mortality rates in HIV-infected people remain high in the era of highly active antiretroviral treatment (HAART). The objective of this paper was to examine causes of deaths in the Australian HIV Observational Database (AHOD) and compare risk factors for HIV-related and HIV-unrelated deaths. Methods: Data from AHOD, an observational study of people with HIV attending medical sites between 1999 and 2004, were analysed. Primary and underlying causes of death were ascertained by sites completing a standardised cause of death form. Causes of death were then coded as HIV-related or HIV-unrelated. Risk factors for HIV-related and unrelated deaths were assessed using survival analysis among patients who had a baseline and at least one follow-up CD4 and RNA measure. Results: The AHOD had enrolled 2329 patients between 1999 and 2004. During this time, a total of 105 patients died, with a crude mortality rate of 1.58 per 100 person years. Forty-two (40%) deaths were HIV-related (directly attributable to an AIDS event), 55 (52%) HIV-unrelated (all other causes), and eight had unknown cause of death. Independent risk factors for HIV-related deaths were low CD4 count and receipt of a larger number of antiretroviral treatment combinations. Among HIV-unrelated deaths, low CD4 count and older age were independent risk factors. Conclusions: In AHOD in the HAART era, mortality in people with HIV remains around 10-fold higher than in the general population. In our analyses, HIV-unrelated deaths were associated with more advanced HIV disease in a similar way to HIV-related deaths.

Additional keywords: AIDS, death, highly active antiretroviral therapy


Acknowledgements

The Australian HIV Observational Database is funded by a grant from the Clinical Trials and Research Committee of the Australian National Council on AIDS, Hepatitis C and Related Diseases. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales.


The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study principal investigator, Jens D Lundgren, and study coordinator, Nina Friis-Moller for use of the DAD study death form as a basis to develop the AHOD death form.


References


[1] Correll PK,  Law MG,  McDonald AM,  Cooper DA,  Kaldor JM. HIV disease progression in Australia in the time of combination antiretroviral therapies. Med J Aust 1998; 169(9): 469–72.
PubMed |

[2] Mocroft A,  Vella S,  Benfield TL,  Chiesi A,  Miller V,  Gargalianos P, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet 1998; 352(9142): 1725–30.
CrossRef | PubMed |

[3] Mocroft A,  Brettle R,  Kirk O,  Blaxhult A,  Parkin JM,  Antunes F, et al. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS 2002; 16(12): 1663–71.
CrossRef | PubMed |

[4] Cohen MH,  French AL,  Benning L,  Kovacs A,  Anastos ,  Young M, et al. Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy. Am J Med 2002; 113(2): 91–8.
CrossRef | PubMed |

[5] Jain MK,  Skiest DJ,  Cloud JW,  Jain CL,  Burns D,  Berggren RE. Changes in mortality related to human immunodeficiency virus infection: comparative analysis of inpatient deaths in 1995 and in 1999–2000. Clin Infect Dis 2003; 36(8): 1030–8.
CrossRef | PubMed |

[6] Palella FJ,  Delaney KM,  Moorman AC,  Loveless MO,  Fuhrer J,  Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338(13): 853–60.
CrossRef | PubMed |

[7] Chaisson RE,  Keruly JC,  Moore RD. Association of initial CD4 cell count and viral load with response to highly active antiretroviral therapy. JAMA 2000; 284(24): 3128–9.
CrossRef | PubMed |

[8] Mocroft A,  Ledergerber B,  Katlama C,  Kirk O,  Reiss P,  d’Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 2003; 362(9377): 22–9.
CrossRef | PubMed |

[9] Krentz HB,  Kliewer G,  Gill MJ. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003. HIV Med 2005; 6(2): 99–106.
CrossRef | PubMed |

[10] Bonnet F,  Morlat P,  Chene G,  Mercie P,  Neau D,  Chossat I, et al. Causes of death among HIV-infected patients in the era of highly active antiretroviral therapy, Bordeaux, France, 1998–1999. HIV Med 2002; 3(3): 195–9.
CrossRef | PubMed |

[11] Lewden C,  Raffi F,  Cuzin L,  Cailleton V,  Vilde J-L,  Chene G, et al. Factors associated with mortality in human immunodeficiency virus type 1-infected adults initiating protease inhibitor-containing therapy: role of education level and of early transaminase level elevation (APROCO-ANRS EP11 study). The Antiproteases Cohorte Agence Nationale de Recherches sur le SIDA EP 11 study. J Infect Dis 2002; 186(5): 710–4.
CrossRef | PubMed |

[12] Keiser O,  Taffe P,  Zwahlen M,  Battegay M,  Bernasconi E,  Weber R, et al. All cause mortality in the Swiss HIV Cohort Study from 1990 to 2001 in comparison with the Swiss population. AIDS 2004; 18(13): 1835–43.
CrossRef | PubMed |

[13] Lewden C,  Raffi F,  Chene G,  Sobel A,  Leport C. Mortality in a cohort of HIV-infected adults started on a protease inhibitor-containing therapy: standardization to the general population. J Acquir Immune Defic Syndr 2001; 26(5): 480–2.
PubMed |

[14] Valdez H,  Chowdhry TK,  Asaad R,  Woolley IJ,  Davis T,  Davidson R, et al. Changing spectrum of mortality due to human immunodeficiency virus: analysis of 260 deaths during 1995–1999. Clin Infect Dis 2001; 32(10): 1487–93.
CrossRef | PubMed |

[15] Louie JK,  Hsu LC,  Osmond DH,  Katz MH,  Schwarcz SK. Trends in causes of death among persons with acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy, San Francisco, 1994–1998. J Infect Dis 2002; 186(7): 1023–7.
CrossRef | PubMed |

[16] Carr A,  Morey A,  Mallon P,  Williams D,  Thorburn DR. Fatal portal hypertension, liver failure, and mitochondrial dysfunction after HIV-1 nucleoside analogue-induced hepatitis and lactic acidaemia. Lancet 2001; 357(9266): 1412–4.
CrossRef | PubMed |

[17] Duong M,  Buisson M,  Cottin Y,  Piroth L,  Lhuillier I,  Grappin M, et al. Coronary heart disease associated with the use of human immunodeficiency virus (HIV)-1 protease inhibitors: report of four cases and review. Clin Cardiol 2001; 24(10): 690–4.
PubMed |

[18] Fontas E,  van Leth F,  Sabin CA,  Friis-Moller N,  Rickenbach M,  d’Arminio Monforte A, et al. Lipid profiles in HIV-infected patients receiving combination antiretroviral therapy: are different antiretroviral drugs associated with different lipid profiles? J Infect Dis 2004; 189(6): 1056–74.
CrossRef | PubMed |

[19] Egger M,  May M,  Chene G,  Phillips N,  Ledergerber B,  Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360(9327): 119–29.
CrossRef | PubMed |

[20] Ledergerber B,  Lundgren JD,  Walker AS, et al. Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes. Lancet 2004; 364(9428): 51–62.
CrossRef | PubMed |

[21] Olsen CH,  Gatell J,  Ledergerber B,  Katlama C,  Friis-Moller N,  Weber J, et al. Risk of AIDS and death at given HIV-RNA and CD4 cell count, in relation to specific antiretroviral drugs in the regimen. AIDS 2005; 19(3): 319–30.
PubMed |

[22] Gardner LI,  Holmberg SD,  Williamson JM,  Szczech LA,  Carpenter CC,  Rompalo AM, et al. Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J Acquir Immune Defic Syndr 2003; 32(2): 203–9.
PubMed |

[23] van Sighem A,  Danner S,  Ghani AC,  Gras L,  Anderson RM,  de Wolf F. Mortality in patients with successful initial response to highly active antiretroviral therapy is still higher than in non-HIV-infected individuals. J Acquir Immune Defic Syndr 2005; 40(2): 212–8.
CrossRef | PubMed |

[24] Jensen-Fangel S,  Pedersen L,  Pedersen C,  Larsen C,  Tauris P,  Moller A, et al. Low mortality in HIV-infected patients starting highly active antiretroviral therapy: a comparison with the general population. AIDS 2004; 18(1): 89–97.
CrossRef | PubMed |

[25] van Sighem AI,  van de Wiel MA,  Ghani AC,  Jambroes M,  Reiss P,  Gyssens I, et al. Mortality and progression to AIDS after starting highly active antiretroviral therapy. AIDS 2003; 17(15): 2227–36.
CrossRef | PubMed |

[26] Australian HIV Observational Database Rates of combination antiretroviral treatment change in Australia, 1997–2000. HIV Med 2002; 3(1): 28–36.
CrossRef | PubMed |

[27] Laurichesse HA,  Mortimer J,  Evans BG,  Farrington CP. Pre-AIDS mortality in HIV-infected individuals in England, Wales and Northern Ireland, 1982–1996. AIDS 1998; 12(6): 651–8.
PubMed |

[28] Lunn M,  McNeil D. Applying Cox regression to competing risks. Biometrics 1995; 51(2): 524–32.
PubMed |

[29] Cox DR , Oakes D . Analysis of Survival Data. London: Chapman and Hall; 1984.

[30] SAS. SAS version 8.02. Cary, NC, USA: SAS Institute 8.02; 2001.

[31] STATA. Stata Statistical Software, Release 8.0. College Station, TX: Stata Corporation; 2003.

[32] Australian Bureau of Statistics. Population by age and sex, Australian States and Territories. Canberra: Australian Bureau of Statistics; 2003.

[33] Mocroft A,  Gatell J,  Reiss P,  Ledergerber B,  Kirk O,  Vella S, et al. Causes of death in HIV infection: the key determinant to define the clinical response to anti-HIV therapy. AIDS 2004; 18(17): 2333–7.
CrossRef | PubMed |

[34] Lewden C,  Salmon D,  Morlat P,  Bevilacqua S,  Jougla E,  Bonnet F, et al. Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol 2005; 34(1): 121–30.
CrossRef | PubMed |

[35] Rosenthal E,  Poiree M,  Pradier C,  Perronne C,  Salmon-Ceron D,  Geffray L, et al. Mortality due to hepatitis C-related liver disease in HIV-infected patients in France (Mortavic 2001 study). AIDS 2003; 17(12): 1803–9.
CrossRef | PubMed |

[36] Macias J,  Melguizo I,  Fernandez-Rivera FJ,  Garcia-Garcia A,  Mira J,  Ramos A, et al. Mortality due to liver failure and impact on survival of hepatitis virus infections in HIV-infected patients receiving potent antiretroviral therapy. Eur J Clin Microbiol Infect Dis 2002; 21(11): 775–81.
CrossRef | PubMed |

[37] Lundgren JD,  Mocroft A,  Gatell JM,  Ledergerber B,  d’Arminio Monforte A,  Hermans P, et al. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study. J Infect Dis 2002; 185(2): 178–87.
CrossRef | PubMed |

[38] Smith DK,  Gardner LI,  Phelps R,  Hamburger ME,  Carpenter C,  Klein RS, et al. Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999. J Urban Health 2003; 80(4): 676–88.
PubMed |

[39] Tedaldi EM,  Baker RK,  Moorman AC,  Alzola CF,  Fuhrer J,  McCabe RE, et al. Influence of coinfection with hepatitis C virus on morbidity and mortality due to human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2003; 36(3): 363–7.
CrossRef | PubMed |

[40] Riley ED,  Bangsberg DR,  Guzman D,  Perry S,  Moss AR. Antiretroviral therapy, hepatitis C virus, and AIDS mortality among San Francisco’s homeless and marginally housed. J Acquir Immune Defic Syndr 2005; 38(2): 191–5.
CrossRef | PubMed |

[41] Friis-Moller N,  Sabin CA,  Weber R,  d’Arminio Monforte A,  El-Sadr WM,  Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003; 349(21): 1993–2003.
CrossRef | PubMed |

[42] Egger M,  Junghans C,  Friis-Moller N,  Lundgren JD. Highly active antiretroviral therapy and coronary heart disease: the need for perspective. AIDS 2001; 15(Suppl 5): S193–201.
CrossRef | PubMed |




* Steering committee member.



Appendix 1. The Australian HIV Observational Database

New South Wales. M Gotowski, S Taylor and L Stuart-Hill, Bligh Street Clinic, Tamworth. E Jackson, D Hunter and Linda Lewis, Blue Mountains Sexual Health and HIV Clinic, Katoomba. M Block, D Austen, D Quan, and A Gowers, Holdsworth House General Practice, Darlinghurst. K Brown and N Skobalj, Illawarra Sexual Health, Warrawong. C O’Connor and B Allam, Livingstone Road Sexual Health Centre, Marrickville. D Templeton, Macquarie Sexual Health Centre, Dubbo. M T Liang, Nepean Sexual Health and HIV Clinic, Penrith. D Allen, B Strazdinis, Holden Clinic, Gosford . D Smith and J Armishaw, SHAIDS, Lismore. D Cooper, A Carr and M Lacey, St Vincents Hospital, Sydney. B Donovan, C Pell and B Judd Sydney Sexual Health Centre. R Finlayson and R Richardson, Taylor Square Private Clinic, Darlinghurst. D Ellis, The Medical and Vein Centre, Coffs Harbour. D Baker * , J Kidd, R McFarlane and R Vale 407 Bourke Street, Surry Hills. P Canavan * , National Association of People Living with HIV/AIDS (NAPWA). P Rawstorne * National Centre in HIV Social Research, University of New South Wales. B Mulhall * University of Sydney M Law * , K Petoumenos * , D Smith * , NCHECR, Darlinghurst. Northern Territory. B Hughes, H Lyttle and P Knibbs, Communicable Disease Centre, Royal Darwin Hospital, Darwin. South Australia. G Rogers, S Markinson, C Sullivan, F Downey, M Curry, J Oddy, J Thompson, The Care and Prevention Programme, Adelaide University. Queensland. M Kelly and H Magon, AIDS Medical Unit. D Sowden, and A Walker, Blackall Terrace Specialist Centre, Blackall Terrace. D Orth, G Lister and D Youds, Gladstone Road Medical Centre, Highgate Hill. J Chuah * , N Wendt, W Fankhauser, and B Dickson, Gold Coast Sexual Health Clinic, Miami. D Russell, J Leamy and C D’arcy Evans, Sexual Health Program, Cairns Base Hospital, Cairns. Victoria. T Reid and J Laing, Melbourne Sexual Health Centre, Carlton. I Woolley, T Korman, A Padiglione and K Visvanathan, Monash Medical Centre, Clayton. N Roth * , B Eu, S Strecker and H Wood, Prahran Market Clinic, South Yarra. A Mijch * , J Hoy, A Pierce, M Bryant, C McCormack and K Watson, The Alfred Hospital, Prahran. J Anderson * R Moore, G McGovern, R McNair and K Lowe, The Carlton Clinic, Carlton. Western Australia.  S Mallal * , M French, A Cain, J Skett, and C Moore, Department of Clinical Immunology, Royal Perth Hospital, Perth.



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