gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Causes of death in HIV infected patients

Todesursachen von HIV-Patienten

Meeting Abstract

  • C. Hertenstein - Uniklinik Köln, Klinik I für Innere Medizin, Köln, Germany
  • T. Kümmerle - Uniklinik Köln, Klinik I für Innere Medizin, Köln, Germany
  • S. Koch - Uniklinik Köln, Klinik I für Innere Medizin, Köln, Germany
  • J.J. Vehreschild - Uniklinik Köln, Klinik I für Innere Medizin, Köln, Germany
  • J.C. Wasmuth - Universität Bonn, Medizinische Klinik und Poliklinik, Bonn, Germany
  • J. Rockstroh - Universität Bonn, Medizinische Klinik und Poliklinik, Bonn, Germany
  • G. Fätkenheuer - Uniklinik Köln, Klinik I für Innere Medizin, Köln, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP139

DOI: 10.3205/10kit193, URN: urn:nbn:de:0183-10kit1932

Veröffentlicht: 2. Juni 2010

© 2010 Hertenstein et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Mortality of HIV patients has decreased considerably since the initiation of the HAART. However, the death rate of HIV patients has remained greater than that of HIV-negative individuals. While AIDS-defining illnesses still account for the majority of deaths in AIDS patients, other causes of death play an increasing role.

Methods: Individuals treated at the infectious diseases outpatient wards of the University Hospitals of Cologne and Bonn are included in the Cologne-Bonn-Cohort. Since 1996, approximately 4,000 HIV+ patients have been prospectively followed. For deceased patients, causes of death were systematically recorded according to the „CoDe“-system („Coding of Death in HIV“, D:A:D study). All fatalities between Jan. 1st, 2004 and Dec. 31st, 2008 were evaluated.

Results: 132 deaths (106 m, 26 f) were reported during the time-span between 2004 and 2008. The median age at time of death was 47 years (range: 24-77). In 16 patients (12%), HIV infection had been known for less than one year, in 20 (15%) for 1-5 years, n=80 (61%) for 5-20 years and in 16 (12%) for more than 20 years. Last CD4 count results before the event of death were 0 to 99 cells/µL in 40 (30%), 100-199 cells/µL 21 (16%), 200–349 cells/µL in 29 (22%), and more than 350 cells/µL in 34 patients (26%) (missing data: n=8 (6%)). 110 patients (87.5%) were on antiretroviral therapy (ART) at the time of death, (status not available: n=12 (9%)). HIV-1 RNA at the time of death was below 50 copies/mL in 57 (43%), between 50 and 10,000 copies in n=26 (20%), and greater than 10,000 copies/mL in 37 patients (28%) (unknown: n=9 (7%)). Death was caused by HIV associated diseases in 60 patients (45%), and by other conditions in 54 patients (41%). In 18 patients (14%), causes of death could not be identified. Among HIV associated deaths, malignancies were the leading cause (n=17, 13%), followed by cardiovascular disorders (n=15, 11%) and other infections (non-AIDS defining, n=13, 10%). Liver related deaths occurred in 7 patients (5%).

Conclusion: In our cohort, HIV associated diseases were still the leading causes of death. Despite being on antiretroviral therapy, nearly half of patients had severe immune suppression (CD4 count <200/µL) at time of death. To further improve survival, interventions should mainly aim on re-establishing immune function and on prevention of opportunistic diseases. These results also demonstrate, that causes of death may vary considerably between cohorts.