Non-AIDS mortality in England and Wales in HIV positive vs general population

Sara Croxford from Public Health England (PHE) presented an analysis of non-AIDS mortality in England and Wales among HIV positive people diagnosed from 1997 to 2012.

This is the first UK study to categorise national HIV deaths using the Coding Causes of Death in HIV Project (CoDe) protocol and to compare mortality to the general population.

All-cause deaths of people living with HIV in England and Wales are recorded by direct reporting to PHE by doctors and by linkage to the National Mortality Register at the Office for National Statistics (ONS).

Of 88,994 people diagnosed between 1997 and 2012, a total of 83,276 were included in the analysis who had at least one attendance at an HIV clinic or who had died by end of 2012.

There were 5,302 deaths (6.4%) from 443,818 person years of follow-up. Of these, 58% were AIDS-related and 42% were non-AIDS related. The highest proportions of non-AIDS deaths were caused by cardiovascular disease or stroke (19%), non-AIDS malignancies (19%) and non-AIDS-defining infections (18%), followed by liver disease (12%).

To compare deaths in people living with HIV against those of the general population, a standardised mortality ratio (SMR) was calculated by dividing the deaths in the cohort by expected deaths according to age and sex matched ONS population data. A value of 1.0 would denote there is no difference between the two populations.

Strikingly, the all-cause SMR was substantially higher in the HIV positive cohort, at 5.7. This figure rose to 9.0 when looking at women alone.

Non-AIDS infections and liver disease accounted for the highest differences with the general population, with SMRs of 11.0 and 3.7 respectively. Again, these values increased substantially for women who had an SMR of 18.0 for non-AIDS infections and 4.5 for liver disease.

In this historical cohort that included the first years of combination therapy, mortality rates amongst people with HIV were significantly higher than for the general population, even when AIDS-related deaths are excluded.