20 Jul Death Rate From HIV-AIDS Continues to Drop
Medical Research: What are the main findings of the study?
Dr. Smith: We followed a group of approximately 45,000 HIV-positive people from Europe, USA and Australia between 1999 to 2011. We found that the death rate approximately halved over the 12-year study period. For every 1,000 people, around 18 died per year in 1999-2001, reducing to 9 deaths per year in 2009-2011.
We also studied what people died of. We found that the death rate from AIDS and from liver disease decreased by around two-thirds. Deaths from heart disease approximately halved. However, the rate of cancer deaths (excluding cancers that are classified as AIDS events) remained constant over time.
One in three deaths were caused by AIDS in 1999 to 2011, and this decreased to one in five deaths in the last two years of the study. However, even in recent years it was the joint most common cause of death. The proportion of deaths from cancer increased over time. One in ten deaths were from cancer in 1999 to 2001, and this increased to one in five deaths in 2009 to 2011. By the end of the study it was the joint-most common cause of death.
Medical Research: Were any of the findings unexpected?
Dr. Smith: Although the rate of death from AIDS decreased substantially over the study period, it was surprising that it remained the joint-most common cause of death. It was also disappointing that the rate of cancer deaths had not improved over time.
Medical Research: What should clinicians and patients take away from your report?
Dr. Smith: It is very encouraging that death rates are continuing to decrease among HIV-positive people. It shows how effective antiretroviral treatment has been and continues to be.
It is likely that HIV-positive people are at an increased risk of non-AIDS diseases, including liver disease, heart disease and cancer. Reasons for this may include side-effects of the antiretroviral treatment, lifestyle factors (e.g. smoking is more common among HIV-positive people compared to national averages), or HIV infection itself increasing risk. Our study suggests that HIV-positive people and their clinicians have successfully reduced the frequency of deaths from these other diseases, with the exception of cancer.
Disappointingly, we found AIDS was still the most common cause of death. We must make every effort to ensure that HIV-positive people are able to keep taking their medication regularly so they can experience the benefits of treatment. We must also increase our efforts to ensure that people who are unaware that they have HIV are tested, so they can receive care and treatment in a timely manner.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Smith: Unfortunately, we do not currently have a cure for HIV, and it seems likely that people will have to take antiretroviral drugs for life. We believe that it is important to continue to monitor death rates in HIV-positive people. This is to ensure that the antiretrovirals remain effective over decades of treatment. We are also not yet sure whether decades of antiretroviral treatment will lead to unexpected side-effects. Therefore, we must continue to investigate what HIV-positive people die of, to pick up these potential side-effects as quickly as possible.
Dr Colette J Smith PhD,Lene Ryom PhD,Prof Rainer Weber MD,Philippe Morlat PhD,Prof Christian Pradier MD,Prof Peter Reiss PhD,Justyna D Kowalska PhD,Stephane de Wit PhD,Prof Matthew Law PhD,Prof Wafaa el Sadr MD,Ole Kirk DMSc,Nina Friis-Moller DMSc,Antonella d’Arminio Monforte MD,Prof Andrew N Phillips PhD,Prof Caroline A Sabin PhD,Prof Jens D Lundgren DMSc,for the D:A:D Study Group
The Lancet – 19 July 2014 ( Vol. 384, Issue 9939, Pages 241-248 )