Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

Abstract

Background Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. Methods A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan–Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Results Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate ( P = 0.228), causes of death ( P = 0.771), or survival analysis ( P = 0.089) between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Conclusion Being diagnosed with CD4 < 200 cells/mm 3 at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm 3 group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.

Mortality and Causes of Death among Individuals Diagnosed with Human Immunodeficiency Virus in Korea, 2004–2018: An Analysis of a Nationwide Population-Based Claims Database

“…However, data on mortality and the causes of death of HIV-infected individuals in Korea are limited. To the best of our knowledge, while a few relevant studies have been conducted using single-center data [ 11 , 12 ], none have covered all HIV-infected individuals in Korea.…”

Neurological Disorders of Patients Living with HIV Hospitalized in Infectious Departments of the Specialist Hospital in Lower Silesia in Poland

“…Sadly, in European countries, despite good access to anti-retroviral therapy, laboratory diagnosis or CNS imaging, as well as the possibility of treatment for many opportunistic diseases, AIDS-defining conditions are still the direct cause of death among HIV-infected patients [ 8 ].…”