Long-Term Trends in HIV Mortality Show Prevalence of Underlying Infection

A recent analysis examined long-term trends in HIV-related mortality among individuals living with the disease in New York City, revealing that deaths associated with underlying infection remain prevalent.

The review, which was published in the Archives of Pathology and Laboratory, also demonstrated an increase in longevity of life for individuals living with HIV from 1984 to 2010, which is due to the development of combination antiviral drug therapies, according to the study. Researchers conducted a retrospective analysis of 252 autopsies in adult patients with AIDS or HIV infection.

At the start of the HIV epidemic in 1984, the average age of death in New York City from AIDS was 36 years. By 2010, the average age had risen to 54, according to the findings. Although the frequency of AIDS-defining opportunistic infections increased from 1984, associated deaths declined, the analysis showed.

The leading cause of death among individuals with HIV in New York City continues to be associated with infections, such as pneumocystis pneumonia in the lungs, which can even impact patients who are treated for HIV, according to the researchers. These infections accounted for 100% of deaths from 1984 to 1987, 52% between 1996 and 1999, and 86% from 2012 to 2016.

As individuals with HIV are able to live longer, they are more likely to develop common comorbidities, such as hepatitis C virus (HCV), that can also contribute to death. The researchers noted that three-quarters of individuals autopsied between 2014 and 2015 had HCV and cirrhosis; however, advances in HCV drug therapies are expected to mitigate this.

Of note, the analysis showed a sharp increase in atherosclerosis among individuals with HIV, which increased from 21% between 1988 and 1994 to 54% from 2008 to 2011; however, the researchers noted that this finding has yet to be explained.

“Autopsy reports reliably tell the whole disease story and why people are still dying from it,” Amy V. Rapkiewicz, MD, an associate professor in the Department of Pathology at NYU Langone and vice chair of pathology at NYU Winthrop Hospital, said in a press release. “That is because there is often a difference between the immediately reported cause of death, such as heart attack, and the actual cause of death, whether from obesity, drug use, or HIV and AIDS.”

The findings suggest that despite advances in treatment, individuals with HIV are still dying predominantly from the underlying disease and not just factors related to old age, Rapkiewicz stated.

The researchers cautioned that the analysis only reflects HIV trends in New York City and not on a national scale.

References

Nizami S, Morales C, Hu K. Trends in mortality from human immunodeficiency virus infection, 1984-2016: an autopsy-based study. Archives of Pathology & Laboratory Medicine. 2019. https://doi.org/10.5858/arpa.2019-0144-OA

HIV-Positive New Yorkers Are Living Longer but Still Dying of Underlying Infection [news release]. NYU Langone Health. https://nyulangone.org/news/hiv-positive-new-yorkers-are-living-longer-still-dying-underlying-infection. Accessed August 29, 2019.