The Modern Era
Focusing on the period from 2005 to 2010, a total of 459 HIV-positive members of the SHCS died. The average profile of these people at their time of death was as follows:
- 74% men, 26% women
- age -- 47 years
- duration of HIV infection -- 14 years
- ART was used by 93% of participants
- CD4+ count -- 251 cells
- active HCV infection -- 45%
- active HBV infection -- 11%
- 36% had a history of injecting street drugs
Causes of Death in the Modern Era
Major causes of death were as follows:
- non-AIDS-related cancers (including liver cancer) -- 19%
- AIDS-related causes -- 16%
- liver failure (excluding cases of liver cancer) -- 15%
- non-AIDS-related infections -- 9%
- complications from substance use -- 7%
- suicide -- 6%
- heart attack -- 6%
Focus on Suicide
Generally, men and women died from similar causes. One major exception was suicide: The overall rate in the modern era was 6%, but when broken down by gender, suicide was responsible for 8% of deaths in men and 3% in women.
It is noteworthy that in the pre-ART era the overall suicide rate was about 3% but rose up to 6% in the modern era. This doubling of the suicide rate underscores the need for more vigilance in screening and treating depression.
CD4+ Cell Counts
Although the majority of deaths occurred in people with 499 or less CD4+ cells, 20% of deaths occurred in people who had 500 or more CD4+ cells.
Common causes of death among people co-infected with hepatitis-causing viruses included the following:
- liver failure (including liver cancer) -- 32%
- non-AIDS-related infections -- 14%
- complications arising from substance use -- 11%
Taking many factors into account, the following were linked to an increased risk of death among the 459 people who died:
- injecting street drugs
- being over the age of 40
- having a low CD4+ cell count (less than 200 cells)
- smoking tobacco
- having type 2 diabetes
- being underweight
- having untreated HBV or HCV
- a history of a heart attack
- interrupting ART
The results of the Swiss study are important because they document the shifting causes of death among people with HIV over the past 20 years. Such shifts are being seen to varying degrees across high-income countries -- such as Canada, Denmark, France and the U.S. -- and the Swiss study may be a harbinger of the future for some HIV-positive people if additional steps are not taken.
ART has tremendously improved the chances of survival among HIV-positive people, with some studies predicting near-normal life expectancies. However, if the survival benefit of ART is to be extended, then causes of death mentioned in the Swiss study need to be addressed. Medical and psychosocial interventions are necessary to improve the health of HIV-positive people, particularly those co-infected with HBV and HCV infections, some of whom are also struggling with addiction and mental and emotional health issues. Metabolic complications such as pre-diabetes and type 2 diabetes and cardiovascular disease risks also need to be addressed.
- Weber R, Ruppik M, Rickenbach M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Medicine. 2012; in press.
- Lohse N, Hansen AB, Pedersen G, et al. Survival of persons with and without HIV infection in Denmark, 1995-2005. Annals of Internal Medicine. 2007 Jan 16;146(2):87-95.
- Lohse N, Gerstoft J, Kronborg G, et al. Comorbidity acquired before HIV diagnosis and mortality in persons infected and uninfected with HIV: a Danish population-based cohort study. Journal of Acquired Immune Deficiency Syndromes. 2011 Aug 1;57(4):334-9.
- Ly KN, Xing J, Klevens RM, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Annals of Internal Medicine. 2012 Feb 21;156(4):271-8.
- Lohse N, Hansen AB, Gerstoft J, et al. Improved survival in HIV-infected persons: consequences and perspectives. Journal of Antimicrobial Chemotherapy. 2007 Sep;60(3):461-3.
- Klein M, Rollet K, Saeed S, et al. HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality. HIV Medicine. 2012; in press.
- Rosenthal E, Salmon-Céron D, Lewden C, et al. Liver-related deaths in HIV-infected patients between 1995 and 2005 in the French GERMIVIC Joint Study Group Network (Mortavic 2005 study in collaboration with the Mortalité 2005 survey, ANRS EN19). HIV Medicine. 2009 May;10(5):282-9.