The number of people living with HIV globally is around 35.3 million, with 1.6 million deaths from AIDS-related illnesses worldwide in 2012.
HIV-positive adults in high-income countries face a reduced risk of death from AIDS-related causes, cardiovascular disease and liver disease, compared with a decade ago.
According to the Centers for Disease Control and Prevention (CDC), more than 1.1 million people in the US are presently living with HIV infection, with almost 1 in 6 (15.8%) unaware that they are infected. An estimated 15,529 people with an AIDS diagnosis died in the US in 2010.
The large international study published in The Lancet medical journal, ahead of AIDS 2014, the 20th International AIDS conference, includes data on patients from more than 200 clinics in the US, Europe and Australia using the "Data collection on Adverse events of anti-HIV Drugs (D:A:D)" cohort study.
Lead researcher Dr. Colette Smith, from University College London in the UK, and the D:A:D cohort investigators examined long-term mortality trends in people with HIV from 1999 to 2011 and followed-up for a median of 6 years.
Increase in death rates from non-AIDS cancers
Death rates from most causes declined over the period of the research. However, non-AIDS cancers increased slightly from 1.6 per 1,000 person-years in 1999-2000 to 2.1 in 2009-2011.
Results indicate that the 3,909 deaths occurring within the study period were due to:
- AIDS-related cause (29%)
- Cancers, with lung cancer the highest risk (15%)
- Liver disease, mainly due to hepatitis (13%)
- Cardiovascular disease (11%).
Cause-of-death analysis showed risk of death from AIDS-related causes, cardiovascular disease and liver disease decreased, compared with a decade ago. Overall mortality from all causes decreased from 17.5 deaths per 1,000 person-years in 1999-2000 to 9.1 in 2009-2011 - a decline of nearly 50%.
Results revealed similar decreases in death rates per 1,000 person-years for AIDS-related causes (5.9-2.0), liver disease (2.7 to 0.9) and cardiovascular disease (1.8 to 0.9). The percentage of deaths due to AIDS and liver disease declined over time, while deaths due to non-AIDS cancers increased:
- AIDS-related cause - decreased from 34% to 22%
- Liver disease - decreased from 16% to 10%
- Non-AIDS cancers - increased from 9% to 23%.
Non-AIDS cancers are now the leading non-AIDS cause of death in people with HIV, accounting for 23% of all deaths.
Dr. Colette Smith says:
"These recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count and provide further evidence of the substantial net benefits of ART [antiretroviral therapy]. But despite these positive results, AIDS-related disease remains the leading cause of death in this population. Continued efforts to ensure good ART adherence and to diagnose more individuals at an earlier stage before the development of severe immunodeficiency are important to ensure that the low-death rate from AIDS is sustained and potentially decreased even further."
The researchers state that the fall in death rate percentages cannot be attributed to changes over time in patient demographics, improvements in viral suppression or changes in the CD4 cell count, as the percentage of participants with high blood pressure, diabetes and high body mass index increased over time.
However, they take note that the decrease may be due to improved management of smoking, alcohol use and hepatitis, or the use of less toxic ART regimens during the study.
'We are still early in the ART era'
"The benefits of ART are unquestioned, and their beneficial effect on the HIV epidemic continues to grow. Still, clear limitations exist because many patients are not accessing treatment, and some problems persist even in those on ART, including a higher than expected risk of non-AIDS cancers and other morbidities," Steven Deeks and Peter Hunt from the University of California-San Francisco say in a linked comment.
"Finally, it needs to be emphasized that we are still early in the ART era. In the absence of a cure, most patients will need to continue on ART for decades. Continued monitoring for unexpected consequences of treatment will be needed indefinitely," they add.
The paper concludes a need for further research to recognize why the risk of dying from a non-AIDS cancer remains high, together with an assessment of the effect of specific antiretroviral drugs on non-AIDS cancer rates.
Last month, Medical News Today reported What is discouraging HIV testing among at-risk populations? In line with National HIV Testing Day on Friday, June 27th, we took a look at the signs and symptoms of the virus and discussed why many people are discouraged from being tested for HIV.