Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study

AIDS. 2010 Jun 19;24(10):1537-48. doi: 10.1097/QAD.0b013e32833a0918.


Objective: To investigate any emerging trends in causes of death amongst HIV-positive individuals in the current cART era, and to investigate the factors associated with each specific cause of death.

Design: An observational multicentre cohort study.

Methods: All HIV-positive individuals included in one of the cohorts in the Data Collection on Adverse Events of Anti-HIV drugs (D:A:D) Study were included. The association between HIV-specific and non HIV-specific risk factors and death were studied using multivariable Poisson regression.

Results: We observed 2482 deaths in 180,176 person-years (PY) on 33,308 individuals [rate/1000 PY = 13.8 (95% CI 13.2-14.3)]. Primary causes of death were: AIDS (n = 743; rate/1000 PY = 4.12), liver-related (341; 1.89), CVD-related (289; 1.60), non-AIDS malignancy (286; 1.59). The overall rate of death fell from 16.9 in 1999/2000 to 9.6/ 1000 PY in 2007/2008. Smoking was associated with CVD and non-AIDS cancers, HBV and HCV co-infection with liver-related deaths, and hypertension with liver-related and CVD deaths. Diabetes was a risk factor for all specific causes of death except non-AIDS cancers, and higher current HIV RNA for AIDS-related deaths. Lower CD4 cell counts were associated with a higher risk of death from all specific causes of death.

Conclusion: Multiple potentially modifiable traditional and HIV-specific risk factors for death of HIV-infected persons were identified. The maximum reduction in mortality in HIV-infected populations will require that each of these factors be appropriately addressed. No trends in terms of emerging causes of unexpected deaths were observed, although monitoring will continue.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antiretroviral Therapy, Highly Active / mortality*
  • Australia / epidemiology
  • CD4 Lymphocyte Count
  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / virology
  • Cause of Death / trends
  • Europe / epidemiology
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / mortality*
  • HIV Infections / virology
  • Humans
  • Male
  • Neoplasms / mortality*
  • Neoplasms / virology
  • Risk Factors
  • United States / epidemiology