J Korean Med Sci.  2020 Oct;35(41):e355. 10.3346/jkms.2020.35.e355.

Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

• Kim Y
• Kim SW
• Chang HH
• Kwon KT
• Bae S
• Hwang S

• KMID: 2507827
• DOI: http://doi.org/10.3346/jkms.2020.35.e355

Abstract

Background
Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea.
Methods
A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan–Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups.
Results
Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate (P = 0.228), causes of death (P = 0.771), or survival analysis (P = 0.089) between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups.
Conclusion
Being diagnosed with CD4 < 200 cells/mm³ at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm³ group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.

Keyword

Cause of Death; Human Immunodeficiency Virus; Human Immunodeficiency Virus Infection; Mortality; Retrospective Cohort

Figure

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  Fig. 1 Kaplan–Meier and log rank tests for 67 patients with confirmed cause of deaths diagnosed with CD4 < 200 cells/mm3 and CD4 ≥ 200 cells/mm3 at the time of HIV diagnosis.HIV = human immunodeficiency virus.

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  Fig. 2 Changes in cause of death in HIV patients based on the HIV diagnosis period (5-year intervals).HIV = human immunodeficiency virus, CVD = cerebrovascular disease, TB = tuberculosis, PCP = Pneumocystis pneumonia.

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  Fig. 3 Changes in cause of death in HIV patients based on the HIV diagnosis period according to the AIDS-related death classification (5-year intervals).HIV = human immunodeficiency virus, AIDS = acquired immunodeficiency syndrome.

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