Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003
Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003
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DOI：
10.1111/j.1468-1293.2005.00271.x
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发表时间：
2005-03-01
期刊：
影响因子：
3
通讯作者：
Gill, MJ
中科院分区：
文献类型：
--
作者：
Krentz, HB;Kliewer, G;Gill, MJ
目的研究的死亡率和死亡的原因在一个地理定义的HIV感染population.Methods的日期和死亡原因的所有患者记录在南阿尔伯塔1984年和2003年之间的初级保健信息的数据库搜索的变化。获得社会人口统计学和临床特征。然后通过审查患者的医院图表、尸检报告或死亡证明来单独确认死亡原因，并使用国际疾病分类第9版进行编码。艾滋病死亡人数与公共卫生报告相符。时间跨度分为前高效抗逆转录病毒治疗（HAART）（1984-1996）和当前HAART（1997-2003）periods.Results之间1984年和2003年，有560例死亡，1987年艾滋病毒感染者生活在南阿尔伯塔。其中，436例死亡（78%）发生在HAART治疗前，124例（22%）发生在当前HAART治疗期间。粗死亡率从HAART前的117例死亡/1000患者年下降到当前HAART期间的24例。在前HAART时代，90%的死亡与艾滋病有关，而在目前的HAART时代，只有67%与艾滋病有关。艾滋病死亡的主要原因是艾滋病多种原因（31%），鸟分枝杆菌复合体（18%），肺囊虫肺炎（10%）和非霍奇金淋巴瘤（7%）。非艾滋病相关死亡的比例从HAART前的7%增加到当前HAART时代的32%。意外死亡，包括药物过量（29%），自杀（7%）和暴力（3%），肝病（19%），非艾滋病相关的恶性肿瘤（19%）和心血管疾病（16%）占非艾滋病相关死亡的大多数。没有发现药物毒性直接导致的死亡，总体而言，21%的死亡患者是抗逆转录病毒（ARV）初治患者。总共有14%死于艾滋病的患者未接受过抗逆转录病毒治疗，而35%死于非艾滋病毒相关疾病。在所有死于艾滋病的人中，23%在初次诊断后不到3个月死亡，反映了晚期表现。在当前的HAART时代，87%死于艾滋病的患者接受了广泛治疗，反映了HAART治疗失败主要是由于多类耐药性（42%），尽管有ARV，但疾病进展不可避免（32%），缺乏维持终身HAART计划的能力或兴趣（21%），很少，药物不耐受（< 1%）。结论艾滋病相关原因导致的死亡显著减少，但非艾滋病相关原因导致的死亡增加，无论是死亡的绝对数量还是占W感染患者死亡总数的比例。艾滋病毒感染者的年龄增加，平均CD 4计数增加，静脉吸毒者比例增加，B型肝炎病毒和丙型肝炎病毒增加。
Objectives To examine changes over a 2-year period in both the mortality rate and the causes of death in a geographically defined HIV-infected population.Methods A database search of primary care information for the dates and causes of death for all patients documented with HIV infection and living in Southern Alberta between 1984 and 2003 was under-taken. Sociodemographic and clinical characteristics were obtained. Causes of death were then individually confirmed by reviewing the patients' hospital charts, autopsy reports, or death certificates and coded using the International Classification of Diseases, 9th Revisions. AIDS deaths were reconciled with Public Health Reports. The time span was divided into pre-highly active antiretroviral therapy (HAART) (1984-1996) and current HAART (1997-2003) periods.Results Between 1984 and 2003, there were 560 deaths in the 1987 individuals living with HIV infection in Southern Alberta. Of these, 436 deaths (78%) occurred pre-HAART and 124 (22%) in the current HAART period. The crude mortality rate declined from 117 deaths per 1000 patient-years pre-HAART to 24 in the current HAART period. In the pre-HAART era, 90% of all deaths were AIDS related whereas only 67% were AIDS related in the current HAART era. The leading causes of AIDS deaths were AIDS multiple causes (31%), Mycobacterium avium complex (18%), Pneumocystis pneumonia (10%) and non-Hodgkin's lymphoma (7%). The proportion of non-AIDS related deaths increased from 7% pre-HAART to 32% in the current HAART era. Accidental deaths, including drug overdose (29%), suicide (7%) and violence (3%), hepatic disease (19%), non-AIDS related malignancies (19%), and cardiovascular disease (16%) accounted for the majority of non-AIDS related deaths. No deaths directly caused by drug toxicity were found. Overall, 21% of patients who died were antiretroviral (ARV)-naive. A total of 14% of patients dying from AIDS were ARV-naive in contrast to 35% dying from non-HIV related conditions. Of all those dying from AIDS, 23% died < 3 months after their initial diagnosis, reflecting late presentation. In the current HAART era, 87% of patients who died from AIDS were extensively treated, reflecting HAART treatment failures due mostly to multiclass drug resistance (42%), inexorable disease progression despite ARV (32%), lack of ability or interest to be maintained on a lifelong HAART programme (21%) and, rarely, drug intolerance (< 1%).Conclusions Deaths from AIDS-related causes have decreased significantly, but deaths from non-AIDS related conditions have increased, both as an absolute number of deaths and as a proportion of all deaths in W-infected patients. The increasing age of the HIV population, and the increased mean CD4 count, increased proportion of intravenous drug users, increased hepatitis B virus and hepatitis C virus.