People diagnosed late in the UK are six times more likely to die of AIDS

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A twelve-year analysis of deaths in people with HIV in the United Kingdom has shown that people who are diagnosed late are six times more likely to die of AIDS than other people with HIV, Ruth Smith told the British HIV Association conference in Bournemouth yesterday. Three quarters of AIDS deaths can be attributed to late diagnosis (i.e. with a CD4 cell count below 350 cells/mm3).

Researchers have analysed deaths recorded in the UK’s national HIV surveillance systems, supplemented by the death certificate records of the Office of National Statistics, for the years 1997 to 2008.

Since the introduction of combination therapy, there has been a dramatic decline in deaths of people with HIV. The crude mortality rate for people aged 15 to 59 fell from 21.8 per 1000 in 1997 to 8.2 per 1000 in 2008. Nonetheless over 500 people with HIV die each year, and rates are around five times higher than in the general population.

Glossary

odds ratio (OR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

matched

In a case-control study, a process to make the cases and the controls comparable with respect to extraneous factors. For example, each case is matched individually with a control subject on variables such as age, sex and HIV status. 

non-Hodgkin lymphoma

A group of lymphomas (cancers of the lymphatic system). The many types of non-Hodgkin lymphoma (NHL) are classified according to how fast the cancer spreads. Although the symptoms of NHLs vary, they often include swollen lymph nodes, fever, and weight loss. Certain types of NHLs, such as Burkitt lymphoma and immunoblastic lymphoma, are AIDS-defining cancers in people with HIV.

cerebral

Involving the brain.

Over the twelve-year period, 49% of deaths were due to AIDS. This proportion has fluctuated over the years, but is not in steady decline.

The researchers then conducted a case-control analysis. Each case of a person dying of AIDS was matched with four controls who continued with live with HIV and who were matched for their date of diagnosis and age at diagnosis.

In multivariate analysis, after controlling for confounding factors, individuals diagnosed with a CD4 cell count below 350 cells/mm3 were six times more likely than others to die of AIDS (odds ratio 6.1, 95% confidence interval 4.9-7.5).

The researchers estimate that 74% of all AIDS deaths were attributable to late diagnosis. Even among individuals infected in the UK, 66% of AIDS deaths could be attributed to late diagnosis.

In demographic terms and still in multivariate analysis, men were more likely than women to die of AIDS (odds ratio 1.3). However men who have sex with men were less likely to die than men and women infected through heterosexual contact, whether they were probably infected in Africa (odds ratio 1.4), the UK (odds ratio 1.5) or elsewhere (1.4).

Injecting drug users had a much higher risk of death – using men who have sex with men as the comparison group, the odds ratio was 3.0.

The most common causes of AIDS deaths were PCP, other AIDS-related pneumonias, non-Hodgkin's lymphoma, TB and neuro-cerebral causes.

The researchers say their findings point to the importance of earlier diagnosis and treatment in order to prevent deaths of people with HIV.

References

Smith R et al. Dying of AIDS in the era of HAART: a national audit. 17th annual British HIV Association conference, Bournemouth, abstract 012, 2011.