Since the advent of effective combination antiretroviral therapy, the rate of death due to AIDS has decreased while mortality due to other causes has risen.

To better understand this shift, researchers examined trends over time and risk factors for deaths due to accidents and injuries among HIV positive and HIV negative participants in 2 large cohorts: the Women's Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS).

Information on cause of death was collected for all deceased participants in the MACS and WIHS cohorts. Mortality rates were calculated on the basis of risk factors and time period:

" Pre-HAART (before 1997)
" HAART era (1997-2002)

Results

• Information on the cause of death was available for 619 women in the WIHS (who died during the period 1994-2002) and 1830 men in the MACS (who died during the period 1984-2002).

• The rate of mortality related to accident or injury was significantly higher among the WIHS women compared with the men in MACS.

• In the WIHS cohort, the rate of death due to accident or injury was 2.96 deaths per 1000 person-years [PY] for both HIV positive and HIV negative women.

• In the MACS cohort, the rate of death due to these causes was 0.79 per 1000 PY for HIV positive men and 0.63 per 1000 PY for HIV negative men.

• In the final multivariate analysis, the following factors were associated with a significantly higher risk of death in women:

- decreased CD4 cell count;
- unemployment;
- heavier alcohol use;
- injection drug use.

• In men, the significant predictors of death were:

- higher education;
- depressive symptoms;
- larger number of sex partners.

Conclusion

"The characteristics of the men in the MACS who died and women in the WIHS who died differ, as do the risk factors for mortality," the authors concluded. "These results characterize important target groups for interventions to reduce accident- and injury-related deaths."

02/02/07

Reference
N A Hessol, A Kalinowski, L Benning, and others. Mortality among participants in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. Clinical Infectious Diseases 44(2): 287-294. January 15, 2007.