Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers

AIDS. 2006 Jan 2;20(1):67-71. doi: 10.1097/01.aids.0000196178.73174.24.


Objectives: To describe the characteristics of deaths that occur among HIV-positive individuals in the HAART era.

Design: Observational database.

Methods: Deaths were reviewed that occurred among HIV-positive individuals seen at the Royal Free Hospital, London between January 1998 and December 2003.

Results: Over the study period, there were 121 deaths; death rates declined from approximately 2.0/100 person-years of follow-up in 1998-2000 to approximately 1.0/100 person-years of follow-up in 2001-2003. Approximately one half of deaths (45.5%) were from AIDS-related causes and 74 deaths (61.2%) occurred in individuals who had received HAART: patients had been exposed to a median of seven (range 2-14) antiretroviral drugs and two-fifths had started treatment in the pre-HAART era. Another 15 patients had received only non-HAART treatment regimens prior to death. The median pre-death CD4 cell counts were 68 and 167 cells/microl among those who had and had not received HAART; 23 (31.1%) and 4 (8.5%) had HIV RNA < 400 copies/ml, respectively. Of the patients exposed to HAART for at least 6 months and who experienced viral rebound, information was available on resistance for 26 (21.5% of the total deaths) and 19 of those tested had at least one resistance mutation (median 5, range, 1-16).

Conclusions: While mortality rates among HIV-infected individuals at our centre have fallen since 1988, the deaths that do now occur are more diverse and are the result of a number of factors, including late presentation, delayed uptake of HAART and the previous use of treatment combinations that are now viewed as suboptimal.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Retroviral Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active / mortality*
  • Biomarkers / blood
  • CD4 Lymphocyte Count
  • Cause of Death
  • Drug Resistance, Viral / genetics
  • Female
  • Genotype
  • HIV Infections / drug therapy
  • HIV Infections / genetics
  • HIV Infections / mortality*
  • HIV Seropositivity / drug therapy
  • HIV Seropositivity / genetics
  • HIV Seropositivity / mortality
  • Humans
  • London / epidemiology
  • Male
  • Middle Aged
  • Mutation
  • Prospective Studies
  • RNA, Viral / blood
  • Time Factors


  • Anti-Retroviral Agents
  • Biomarkers
  • RNA, Viral