Risk factors and causes of death in the Australian HIV Observational Database
Kathy Petoumenos A C , Matthew G. Law A andA National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria Street, Darlinghurst, NSW 2010, Australia.
B Contributors to the Australian HIV Observational Database are listed in the appendix.
C Corresponding author. Email: kpetoumenos@nchecr.unsw.edu.au
Sexual Health 3(2) 103-112 https://doi.org/10.1071/SH05045
Submitted: 21 September 2005 Accepted: 24 February 2006 Published: 26 May 2006
Abstract
Introduction: Mortality rates in HIV-infected people remain high in the era of highly active antiretroviral treatment (HAART). The objective of this paper was to examine causes of deaths in the Australian HIV Observational Database (AHOD) and compare risk factors for HIV-related and HIV-unrelated deaths. Methods: Data from AHOD, an observational study of people with HIV attending medical sites between 1999 and 2004, were analysed. Primary and underlying causes of death were ascertained by sites completing a standardised cause of death form. Causes of death were then coded as HIV-related or HIV-unrelated. Risk factors for HIV-related and unrelated deaths were assessed using survival analysis among patients who had a baseline and at least one follow-up CD4 and RNA measure. Results: The AHOD had enrolled 2329 patients between 1999 and 2004. During this time, a total of 105 patients died, with a crude mortality rate of 1.58 per 100 person years. Forty-two (40%) deaths were HIV-related (directly attributable to an AIDS event), 55 (52%) HIV-unrelated (all other causes), and eight had unknown cause of death. Independent risk factors for HIV-related deaths were low CD4 count and receipt of a larger number of antiretroviral treatment combinations. Among HIV-unrelated deaths, low CD4 count and older age were independent risk factors. Conclusions: In AHOD in the HAART era, mortality in people with HIV remains around 10-fold higher than in the general population. In our analyses, HIV-unrelated deaths were associated with more advanced HIV disease in a similar way to HIV-related deaths.
Additional keywords: AIDS, death, highly active antiretroviral therapy
Acknowledgements
The Australian HIV Observational Database is funded by a grant from the Clinical Trials and Research Committee of the Australian National Council on AIDS, Hepatitis C and Related Diseases. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales.
The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study principal investigator, Jens D Lundgren, and study coordinator, Nina Friis-Moller for use of the DAD study death form as a basis to develop the AHOD death form.
[1] Correll PK, Law MG, McDonald AM, Cooper DA, Kaldor JM. HIV disease progression in Australia in the time of combination antiretroviral therapies. Med J Aust 1998; 169(9): 469–72.
| PubMed | National Centre in HIV Social Research, University of New South Wales. B Mulhall * University of Sydney M Law * , K Petoumenos * , D Smith * , NCHECR, Darlinghurst. Northern Territory. B Hughes, H Lyttle and P Knibbs, Communicable Disease Centre, Royal Darwin Hospital, Darwin. South Australia. G Rogers, S Markinson, C Sullivan, F Downey, M Curry, J Oddy, J Thompson, The Care and Prevention Programme, Adelaide University. Queensland. M Kelly and H Magon, AIDS Medical Unit. D Sowden, and A Walker, Blackall Terrace Specialist Centre, Blackall Terrace. D Orth, G Lister and D Youds, Gladstone Road Medical Centre, Highgate Hill. J Chuah * , N Wendt, W Fankhauser, and B Dickson, Gold Coast Sexual Health Clinic, Miami. D Russell, J Leamy and C D’arcy Evans, Sexual Health Program, Cairns Base Hospital, Cairns. Victoria. T Reid and J Laing, Melbourne Sexual Health Centre, Carlton. I Woolley, T Korman, A Padiglione and K Visvanathan, Monash Medical Centre, Clayton. N Roth * , B Eu, S Strecker and H Wood, Prahran Market Clinic, South Yarra. A Mijch * , J Hoy, A Pierce, M Bryant, C McCormack and K Watson, The Alfred Hospital, Prahran. J Anderson * R Moore, G McGovern, R McNair and K Lowe, The Carlton Clinic, Carlton. Western Australia. S Mallal * , M French, A Cain, J Skett, and C Moore, Department of Clinical Immunology, Royal Perth Hospital, Perth.
