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October 13, 1997

Causes of Death of HIV-Infected Persons in Ottawa, Ontario, 1984-1995

Author Affiliations

From the Division of General Medicine (Drs Kravcik and Victor) and Division of Infectious Diseases (Drs Victor, Angel, Garber, and Cameron), Department of Medicine, and Department of Nursing (Mss Hawley-Foss, Page, Denommé, and O'Reilly), Ottawa General Hospital, Ottawa, Ontario.

Arch Intern Med. 1997;157(18):2069-2073. doi:10.1001/archinte.1997.00440390055008

Background:  Acquired immunodeficiency syndrome (AIDS) has become a leading cause of death of young men in the United States. With the introduction of prophylaxes and antiretrovirals for opportunistic infection, there have been significant changes in the clinical history of human immunodeficiency virus (HIV) infection.

Objective:  To determine the cause of death of the patients followed up by our clinic from 1984 to 1995.

Methods:  A critical chart review was performed on the records of all patients affiliated with the Ottawa General Hospital HIV/AIDS Clinic, Ottawa, Ontario, who died between 1984 and July 15, 1995. Data regarding the cause of death, last CD4 T-lymphocyte cell count before death, medication use at time of death, and location and year of death were collected. Data were analyzed for 1984 through 1988, 1989 through 1991, and 1992 through 1995, corresponding to the evolution of HIV-related medical care.

Results:  The median CD4 T-lymphocyte cell count at death has declined. Pneumocystis carinii pneumonia has decreased significantly as cause of death (28.6%-3.8%, p<.001). No other specific attributable terminal illness has decreased in frequency during 11 years. The wasting illnesses, particularly HIV wasting syndrome (3.6%13.7%, p=.04), and untreatable illnesses have increased in frequency as causes of death. Patients are increasingly likely to die at home (0%-25%, P<.001) and less likely to die in hospital (54%-35%, P<.001).

Conclusions:  The HIV-infected persons are dying with more advanced HIV immunosuppression. Advances in P carinii pneumonia prophylaxis and treatment have had a dramatic effect on the cause of death of HIV-infected persons. Improved prophylaxis and treatment for non— P carinii pneumonia opportunistic infections and malignancies and HIV wasting syndrome are required.Arch Intern Med. 1997;157:2069-2073