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Shifting Trends in Underlying Causes of Death in HIV-Positive Population

For years after HIV was first identified and recognized by the medical community in 1981, it meant certain death for those who acquired it. HIV invariably progressed to full-blown AIDS, a fatal condition. However, with the advent of highly active antiretroviral therapy (HAART), introduced in 1995, the landscape for HIV-positive people changed. HAART can keep the virus at bay and bolster immune function to the point that many HIV-infected individuals can now live normal lifespans. However, although many of these individuals are no longer dying due to HIV-related issues, they are succumbing to other medical problems that may be completely unrelated to their HIV status, such as diabetes, kidney and liver disease, heart disease, or stroke. In other words, they’re dying with HIV, but not because of it.
A team of researchers at the Centers for Disease Control and Prevention (CDC) looked at data on the underlying causes of death that were reported to the CDC’s National HIV Surveillance System in 23 jurisdictions—20 states along with Los Angeles County, San Francisco County, and Philadelphia. The researchers looked at the death rate for people with AIDS between 1990 and 2011, not just those infected with HIV, due to the fact that in the early 1990s there was little data available on people who were HIV-positive who had not yet developed AIDS. They also examined data on all individuals who were identified as HIV-positive from 2000 to 2011, to find out whether or not they had AIDS. Finally, they examined selected characteristics of all deceased HIV-positive people from 2007 to 2011 to identify potential associations among them.
During the 21-year period from 1990 to 2011, the death rate from causes directly attributable to HIV decreased by 89%. The death rate from non-HIV causes also decreased, by 57%. Reflecting the advancements in treatment, particularly HAART, the percentage of deaths attributable to factors other than HIV infection grew from 11% to 43% in HIV-infected individuals, even as the total number of deaths per year decreased. From 2000 to 2011, a period when it was possible for researchers to make distinctions between those who are infected with HIV and people with AIDS, the death rate from HIV-related causes shrank by 69%, while the rate from non-HIV causes went down by 28%. Again, the percentage of deaths directly due to HIV decreased over the 10-year period thanks to the ability of HAART to suppress the virus.
In examining the various characteristics of the people who died during the study period, the scientists made several observations. They observed that the death rate was higher for black people in both the HIV-caused and non-HIV-caused death groups. It’s possible, according to the researchers, that blacks infected with HIV may not get treatment because they lack health insurance, are abusing drugs, or are afraid they’ll be denied care due to the stigma of HIV. Another discovery was that death rates were highest in people with a history of intravenous drug use, which supports previous findings that this population is more likely to have coexisting health conditions such as hepatitis B and C.

The death rate was higher among older individuals, as would be expected, but the team noted that this held true not just for deaths attributable to heart disease and cancer, but also to HIV. Why older individuals with HIV would succumb to its effects at a greater rate than younger HIV-positive people is open to interpretation, the scientists said, and offered the possibility that “typical” diseases of advancing age may make it harder for the body to keep the complications of HIV at bay. 
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.
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