CHANGING PATTERNS OF OPPORTUNISTIC ILLNESS AND MORTALITY IN THE CANADIAN WOMEN'S HIV COHORT

S Walmsley¹, C Hankins², A Rachlis¹, D Burdge³, K Pourreaux², J Shu² and the Canadian Women's HIV Study Group
¹Department of Epidemiology and Biostatistics, University of Toronto; ²McGill University, Oak Tree Clinic; ³University of British Columbia

Background: Since the widespread introduction of HAART therapy in 1997, morbidity and mortality from HIV infection and its complications have declined dramatically.
Objective: To evaluate incidence changes in mortality, opportunistic infections (OI) and malignancy in women participating in the Canadian Women's HIV Study.
Methods: A prospective cohort study. Data were collected from women participating in the study from 1993 to Dec 2002. The complications and causes of mortality were as reported from the participating centers and not confirmed centrally.
Results: Of the 743 women enrolled into the study, 186 (25%) have been diagnosed with a CDC class C AIDS defining OI or malignancy. In total 350 events have been recorded. The most common complication was PCP at an incidence rate of 2.8 per 100 py followed by wasting syndrome at 1.7 per 100 py and esophageal candidiasis at 1.6 per 100 py. The prevalence rate for OI has declined from 31.0% in 1993, to 6.0% in 1997, and 2.1% in 2002. In total 83 women have died over the same time period. The mortality rate was highest in 1995 when 9.2% women died and has continued to decline to 2.8% in 1997 and 0.7% in 2002. Of the deaths the majority were attributable to HIV infection (65%), while 13% were unrelated to HIV infection and 22% were of unknown cause. CNS and pulmonary problems accounted for 44% of all known causes of death. Of note, no woman has died from cervical cancer. The median CD4 count in the 6 months prior to death was significantly lower in those who died of HIV related causes (20/mm³ vs 200/mm³, p<.0001).
Conclusion: As has been demonstrated in cohorts of predominately gay and bisexual men, both morbidity and mortality associated with HIV infection have declined dramatically in this cohort of Canadian women.

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