Mortality trends of HIV-infected patients after the introduction of highly active antiretroviral therapy: analysis of a cohort of 3,322 HIV-infected persons.

INTRODUCTION The implementation of highly active antiretroviral therapies (HAART) has reduced the mortality attributed to the human immunodeficiency virus (HIV) infection. Variation in the specific causes of death has also changed since the implementation of these therapies. METHODS A prospective study was performed in 3322 HIV-infected persons enrolled in Puerto Rico between 1992 and 2003. We measured the mortality rates and the causes of death as listed in the death certificate and analyzed the variation as a function of the antiretroviral therapy (ART) use. Statistical analyses were performed to evaluate differences. RESULTS The study found that persons treated with HAART had significantly lower mortality risk than ART-naïve persons, regardless of gender and the use of injecting drugs. AIDS-defining conditions as a cause of demise were less frequently reported in patients with HAART. Gastrointestinal dysfunction, sepsis, metabolic abnormalities, and non-Kaposi neoplasms were more frequently reported as causes of death in patients treated with HAART. Hepatic failure as cause of death was also more frequent in these patients. The variation in the mortality trends was similar in both genders and according to the presence or absence of intravenous drug use. CONCLUSIONS Highly active antiretroviral therapies (HAART) is associated with significant reduction in mortality and an increment in gastrointestinal dysfunction, sepsis, non-Kaposi neoplasms, and metabolic disorders as listed causes of death. Adverse and toxic profile of ART, along with the potential synergy of concomitant conditions, may accelerate these trends. Continued mortality surveillance of HIV/AIDS is imperative to follow the epidemic changes.