et al. et al. et al. et al. et al. et al. et al. et al. et al.
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Changes in mortality following HIV and AIDS and estimation of the number of people living with diagnosed HIV/AIDS in Australia, 1981–2003

Fatemeh Nakhaee A C D , Deborah Black B , Handan Wand A , Ann McDonald A and Matthew Law A

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

B Faculty of Health Sciences, University of Sydney, Sydney, NSW 1825, Australia.

C Present address: Department of Biostatistics and Epidemiology, Faculty of Health, Haftbagh Highway, Kerman, Iran.

D Corresponding author. Email: fnakhaee@kmu.ac.ir

Sexual Health 6(2) 129-134 https://doi.org/10.1071/SH08007
Submitted: 19 January 2008  Accepted: 5 February 2009   Published: 18 May 2009

Abstract

Objective: To investigate changes in mortality following HIV and AIDS in Australia. Methods: The results of a linkage between HIV/AIDS diagnoses and the National Death Index (NDI) to the end of 2003 were used to estimate mortality rates following HIV/AIDS. Standardised Mortality Ratios (SMRs) were calculated for deaths following HIV, with and without AIDS, in three periods of treatment; before antiretroviral therapy (≤1989), pre- and early-HAART (1990–1996) and HAART (1997–2003). Crude mortality rates were calculated as the number of deaths per 1000 person-years. The total number of people living with HIV/AIDS was estimated. Results: There were 1789 deaths following HIV without AIDS and 6730 deaths after AIDS. For deaths following HIV without AIDS, the SMRs were 2.99, 1.22 and 1.6 during the periods before 1990, 1990–1996 and 1997–2003. For deaths after AIDS the SMRs were 137.84, 28.64 and 4.55 in the periods one to three, respectively. The crude death rate following HIV without AIDS increased from 16.8 before 1986 to 19.6 in 2003. Death rates after AIDS decreased from 958.7 up to 1986 to 60.4 in 2003. The number of new HIV diagnoses increased to 1276 in 1990 then decreased to 780 in 2003, while AIDS diagnoses increased to 950 in 1994 then decreased to 252 in 2003. The total number of people living with HIV was estimated to be 7873 in 1989, and 12828 in 2003. Conclusion: Mortality following AIDS decreased while deaths before AIDS remained low. The number of people living with HIV/AIDS has increased.

Additional keywords: antiretroviral treatment, death, mortality rates.


Acknowledgement

The present study was funded by the National Centre in HIV Epidemiology and Clinical Research and a PhD scholarship (Kerman University of Medical Sciences, Kerman, Iran and Iran Ministry of Health). 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. Its work is overseen by the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis. The National Centre in HIV Epidemiology and Clinical Research Surveillance Program is a collaborating unit of the Australian Institute of Health and Welfare. The contribution of state and territory health departments (Communicable Disease Control Program, ACT Department of Health and Community Care, Australian Capital Territory; Area Health Services, NSW Health Department, New South Wales; AIDS/STD Program, Department of Health and Community Services, Northern Territory; Queensland Health, Queensland; Sexually Transmitted Diseases (STD) Services, Internal Medicine Service, Royal Adelaide Hospital, South Australia; Department of Community and Health Services, Tasmania; STD/Blood-Borne Virus Program, Department of Human Services, Melbourne, Victoria and The Macfarlane Burnet Institute for Medical Research and Public Health Limited, Victoria; Communicable Diseases Control Branch, Department of Health, Western Australia) and the National Blood Borne Virus and Sexually Transmissible Infections Surveillance Committee to ongoing national surveillance for newly diagnosed HIV infection and AIDS in Australia is gratefully acknowledged.


References


[1] Blacker J. The impact of AIDS on adult mortality: evidence from national and regional statistics. AIDS 2004; 18(Suppl 2): S19–26.
CrossRef | 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 1725–30.
CrossRef | CAS | PubMed |

[3] Selik RM,  Byers RH,  Dworkin MS. Trends in diseases reported on U.S. death certificates that mentioned HIV infection, 1987–1999. J Acquir Immune Defic Syndr 2002; 29 378–87.
PubMed |

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

[5] Vittinghoff E,  Scheer S,  O’Malley P,  Colfax G,  Holmberg SD,  Buchbinder SP. Combination antiretroviral therapy and recent declines in AIDS incidence and mortality. J Infect Dis 1999; 179 717–20.
CrossRef | CAS | PubMed |

[6] Messeri P,  Lee G,  Abramson DM,  Aidala A,  Chiasson MA,  Jessop DJ. Antiretroviral therapy and declining AIDS mortality in New York City. Med Care 2003; 41 512–21.
CrossRef | PubMed |

[7] 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 99–106.
CrossRef | CAS | PubMed |

[8] 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 1487–93.
CrossRef | CAS | PubMed |

[9] 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; 338 853–60.
CrossRef | PubMed |

[10] Bloch M , Grulich A , Effler P , Luo K , Kaldor J . Anti-retroviral (ARV) therapies in 471 HIV positive patients in Sydney and Melbourne-treatment and attitudes [abstract]. In: Australian Society for HIV Medicine Inc 7th Annual Conference; 1995 Nov. 16–19; Coolum, Queensland. Abstract number: 87; 1995.

[11] Fagan D , Phillips S , Smith DE , Duncombe C , Anderson B , Buchanan A et al. An observational study of antiretroviral treatment in HIV-infected patients attending general practices in Australia in 1995 [abstract]. In: 3rd International Congress on Drug Therapy in HIV Infection; 1996 Nov. 3–7; Birmingham, UK. Abstract AIDS, 1996, 10 Suppl 2: S30.

[12] 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; 169 469–72.
CAS | PubMed |

[13] Petoumenos K. The role of observational data in monitoring trends in antiretroviral treatment and HIV disease stage: results from the Australian HIV observational database. J Clin Virol 2003; 26 209–22.
CrossRef | PubMed |

[14] 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 1023–7.
CrossRef | PubMed |

[15] 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; 3 195–9.
CrossRef | CAS | PubMed |

[16] 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 1030–8.
CrossRef | PubMed |

[17] Kaldor J,  McDonald AM,  Blumer CE,  Gertig DM,  Patten JJ,  Roberts M, et al. The acquired immunodeficiency syndrome in Australia: incidence 1982–1991. Med J Aust 1993; 158 10–7.
CAS | PubMed |

[18] McDonald AM,  Crofts N,  Blumer CE,  Gertig DM,  Patten JJ,  Roberts M, et al. The pattern of diagnosed HIV infection in Australia, 1984–1992. AIDS 1994; 8 513–20.
CrossRef | CAS | PubMed |

[19] Nakhaee F,  McDonald A,  Black D,  Law M. A feasible method for linkage studies avoiding clerical review: linking of the national HIV/AIDS surveillance databases with National Death Index in Australia. Aust N Z J Public Health 2007; 31 308–12.
CrossRef | PubMed |

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

[21] Larsen SO. Estimation of the number of people in a register from the number of birthdates. Stat Med 1994; 13 177–83.
CrossRef | CAS | PubMed |

[22] Law MG,  McDonald MA,  Kaldor JM. Estimation of cumulative HIV incidence in Australia, based on national case reporting. Aust N Z J Public Health 1996; 20 215–7.
CrossRef | CAS | PubMed |

[23] Law MG,  Rosenberg PS,  McDonald A,  Kaldor JM. Age-specific HIV incidence among homosexually active men in Australia. Med J Aust 1996; 164 715–8.
CAS | PubMed |

[24] Brookmeyer R,  Liao JG. The analysis of delays in disease reporting: methods and results for the acquired immunodeficiency syndrome. Am J Epidemiol 1990; 132 355–65.
CAS | PubMed |

[25] Schanzer DL. HIV/AIDS mortality in trends in Canada, 1987–1998. Can J Public Health 2003; 94 135–9.
PubMed |

[26] Prins M,  Sabin CA,  Lee CA,  Devereux H,  Coutinho RA. Pre-AIDS mortality and its association with HIV disease progression in haemophilic men, injecting drug users and homosexual men. AIDS 2000; 14 1829–37.
CrossRef | CAS | 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; 12 651–8.
CrossRef | CAS | PubMed |

[28] 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 1663–71.
CrossRef | CAS | PubMed |

[29] Vandentorren S,  Mercie P,  Marimoutou C,  Neau D,  Malvy D,  Farbos S, et al. Trends in causes of death in the Aquitaine cohort of HIV-infected patients, 1995–1997. Eur J Epidemiol 2001; 17 7–10.
CrossRef | CAS | PubMed |

[30] Law MG,  Prestage G,  Grulich A,  Van de Ven P,  Kippax S. Modelling the effect of combination antiretroviral treatments on HIV incidence. AIDS 2001; 15 1287–94.
CrossRef | CAS | PubMed |

[31] Clements MS,  Prestage G,  Grulich A,  Van de Ven P,  Kippax S,  Law MG. Modeling trends in HIV incidence among homosexual men in Australia 1995–2006. J Acquir Immune Defic Syndr 2004; 35 401–6.
CrossRef | PubMed |



Rent Article (via Deepdyve) Export Citation Cited By (5)