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HIV death rates have declined dramatically since the availability HAART and effective prophylaxis for opportunistic infections. Given increasing antiretroviral-related complications and resistance, however, whether this decrease in deaths will be sustained is debated.

Some studies continue to describe high rates of death attributable to AIDS-defining conditions. A relatively recent study found that most deaths occurred among patients with a CD4 count of <200 cells/mL and that a leading cause of death remained Pneumocystis carinii (jiroveci) pneumonia (PCP) [MK Jain et al. Clin Inf Dis 36. 2003].

Other studies have shown an increasing proportion of deaths attributable to non-HIV-related conditions, especially to liver failure. In some cohorts, liver disease now accounts for greater than 50% of the deaths among patients with a CD4 count >200 cells/mL or an undetectable HIV viral load.

Divergent results regarding the cause of death are likely related to the underlying characteristics of the study populations, including injectible drug use, coinfection with hepatitis B and C, medication adherence, and the availability of antiretrovirals. In addition, patients with private insurance have been shown to receive more intensive drug regimens and to have lower mortality rates.

A study among patients with open access to medical care as well as a low rate of drug use and hepatitis C coinfection may provide some insight regarding the effects of these barriers on overall mortality. Researchers at several US Military medical centers (primarily naval hospitals) evaluated such a population, US military beneficiaries, to assess causes of death and mortality rates in this cohort during the years 1990 through 2003.

Data collected during this HIV natural history study were retrospectively analyzed for causes of death and annual death rates. The investigators compared death-related variables during the 3 eras.

ResultsThe number of deaths declined over the study period, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era (1997-1999), and 78 deaths in the late HAART era (2000-2003) (P < 0.01). The annual death rate peaked in 1995 (10.3 per 100 patients) and then declined to <2 deaths per 100 persons in the late HAART era (P < 0.01). The proportion of deaths attributable to infection decreased, but infection remained the leading cause of death in this cohort, followed by cancer. Of those who died, there was an increasing proportion of non-HIV-related deaths (32% vs. 9%; P < 0.01), including cardiac disease (22% vs. 8%; P < 0.01) and trauma (8% vs. 2%; P = 0.01) in the post-HAART versus pre-HAART era.

                  • in Africa the death rate as of 2007 is 7 million

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โˆ™ 2013-03-27 15:56:55
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