CAUSES OF MORTALITY IN HIV INFECTED PATIENTS DURING THE HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART) ERA: A ONE-CENTER EXPERIENCE

JS Delisle¹, M Klein², R Lalonde², MD Edwardes³, JP Routy^1,2
1Divison of Hematology, ²Immunodeficiency Service and ³Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, McGill University, Montreal, Quebec

Objective: Review the causes of death after the introduction of HAART in a cohort of patients and evaluate the associated, HIV-related or HIV-unrelated, clinical and laboratory factors.
Methods: Clinical information on patients deceased between January 1997 and June 2002 was abstracted from a prospective computerized database. Medical records were reviewed when death certificates were obtained from the Quebec Ministry of Health (available up to June 2000).
Results: From a total of 1487 patients followed, 131 died during the study period, 103 were men and 28 were women. Mean age at death increased from 41.5 (1997) to 44.4 (2001) years (P=0.27). Of patients with CD4⁺ cell count (N=91) and viral load (VL) (N=98) measured within 6 months of death, 16 had a CD4⁺ cell count above 200 cell/ml and 13 had undetectable VL. Until June 2000, causes of mortality were known for 90 patients. In 18, the cause was unrelated to AIDS and included: anti-retroviral toxicities (N=3), non HIV-related cancers (N=3), suicide (N=2), viral hepatitis (N=2) and others (N=8). Interestingly, 6 of those 18 had CD4⁺ counts above 200 cell/ml. All patients who died violently (N=3) had a psychiatric history. Patients with mental illness (N=26) died generally at a younger age (mean of 40.8 versus 43.5 years; P=0.27) and were significantly more likely to be female (38.5% versus 16.9%- 95% CI on 21.6% difference: 9.1-50.1%). According to physician notes, compliance with medical care was significantly lower in psychiatric patients (42.3 versus 12.7% of patients; 95% CI on 29.6% difference: 9.1-50.1%), contrasting with similar CD4⁺ cell counts and VL.
Conclusion: Since 1997, we observed a trend toward an increased age at death and 20% of patients died of a condition unrelated to AIDS. Among other factors, the impact of mental illness on the course of HIV infection needs to be further investigated.

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