October 16, 2012
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:
Major causes of death were as follows:
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.
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:
Taking many factors into account, the following were linked to an increased risk of death among the 459 people who died:
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.
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