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Introduction: HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. Methods: We included HIV treatment-naive adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. Results: The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). Conclusions: In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival. Keywords: AIDS-defining events; non-AIDS mortality; tuberculosis; Pneumocystis jiroveci pneumonia; non-Hodgkin's lymphoma; marginal structural model, 1 | INTRODUCTION In the era of antiretroviral therapy (ART), there have been striking decreases in acquired immune deficiency syndrome (AIDS)-related mortality [1-3] and prolongation of life expectancy [4-7] for [...]

ABSTRACT The key to understanding the experience of AIDS mortality lies in the stories that people tell each other about those they know who are suspected to have died from [...]

Mortality in HIV-positive persons is increasingly due to non-HIV-related medical comorbidities. There are limited data on the prevalence and patient awareness of these comorbid conditions. Two hundred subjects at an urban HIV clinic were interviewed in 2005 to assess their awareness of 15 non-HIV-related medical comorbidities, defined as medical problems that are neither AIDS-defining by standard definitions, nor a direct effect of immune deficiency. Medical charts were subsequently reviewed to establish prevalence and concordance between self-report and chart documentation. Eighty-four percent of subjects self-reported at least i of 15 medical comorbidities and 92% had at least 1 condition chart-documented. The top 5 chart-documented conditions were hepatitis C (51.5%), pulmonary disease (28.5%), high blood pressure (27%), high cholesterol (24.5%), and obesity (22.5%). In multivariate analysis, higher number of non-HIV--related medical comorbidities was associated with older age, female gender, and intravenous drug use as route of HIV transmission. Across self-reported non-HIV--related medical comorbidities, the absolute concordance rate ranged from 67% to 96%, the sensitivity ranged from 0% to 79%; the positive predictive value ranged from 0% to 100%. While the vast majority of largely urban minority HIV-positive subjects were diagnosed with non-HIV--related medical comorbidities, there is significant room for improvement in patient awareness. In order to help patients optimally access and adhere to medication and medical care for these non-HIV--related medical comorbidities, interventions and educational campaigns to improve patient awareness that take cultural background, literacy, and educational level into account should be developed, implemented, and evaluated. DOI: 10.1089/apc.2009.0152

We examined the relationships between survival after AIDS diagnosis and outpatient mental health service use among men with history of highly active antiretroviral therapy (HAART). Analysis involved 1913 black and 1684 white men with AIDS who received HIV care in 2003 in the Veterans Affairs health care system. Negative binomial regression was used to assess the association between service use and length of AIDS diagnosis. Patients with longer survival after AIDS had higher rates of outpatient visits for stress and adjustment disorders as well as for mood, anxiety, and sexual disorders. Blacks had more visits for stress and adjustment disorders (7.4 versus 5.1; p < 0.05). Multiple regression analysis showed that prolonged survival after AIDS (incident rate ratios [IRR] = 1.87; 95% confidence interval [CI] = 1.25-2.77), having CD4 cell count less than 200 cells/[mm.sup.3] (IRR = 1.91; 95% CI = 1.19-3.04), and mortality (IRR = 3.84; 95% CI = 1.29-11.43) were associated with greater number of visits for mood, anxiety, and sexual disorders. Injection drug users (IRR = 3.52; 95% CI = 1.94-6.38), men who have sex with men (IRR = 2.87; 95% CI = 1.62-5.06), and patients with AIDS-defining illness (IRR = 2.48; 95% CI = 1.474.17) had greater rates of visits for stress and adjustment disorders. Survival after AIDS is associated with mental health service use. As more HIV-infected persons survive longer, adequate risk assessment of mental health concerns that considers race and HIV risk factors should be undertaken to effectively address the impact of mental health on treatment outcomes and mortality. DOI: 10.1089/apc.2009.0177

The impact of HIV/AIDS on household food and nutrition security in Suba district was studied in a quasi longitudinal study. Households with People Living with HIV/AIDS (Index-25%) and three surrounding households (control--75%) were considered for the study. Data were collected on demographic characteristics of the households, land ownership, cultivated land by crop, crop yield, livestock kept by category, diet composition, frequency of hunger, experience of weight loss in the households and expenditure on food. Categorization among the index households was based on disease progression stages: Stage 1(with no symptoms), Stage 2 (Symptomatic-(CD4>200, CD4 Key words: Food, Nutrition, HIV/AIDS, Households, Effect, INTRODUCTION HIV/AIDS continues to be the most crippling and devastating disease creating havoc throughout the world. By the end of 2004, there were about 36-43 million people living with HIV/AIDS [...]

Religious beliefs play an important role in the lives of Tanzanians, but little is known about the influence of religion for people living with HIV/AIDS (PLWHA). This study shares perspectives of PLWHA and identifies opportunities for religious organizations to support the psychological well-being of this group. Data were collected in 2006 and 2007 through semistructured interviews with 36 clients (8 Muslims and 28 Christians) receiving free antiretrovirals (ARVs) in Arusha, Tanzania. Swahili-speaking interviewers asked about participation in religion, change in religious engagement since HIV diagnosis, and what role faith plays in living with HIV and taking ARVs. Interviews were audiotaped, transcribed, translated, and analyzed using Atlas t.i. The findings revealed that patients' personal faith positively influenced their experiences living with HIV, but that religious organizations had neutral or negative influences. On the positive side, prayer gave hope to live with HIV, and religious faith increased after diagnosis. Some respondents said that prayer supported their adherence to medications. On the other hand, few disclosed their HIV status in their religious communities, expressing fear of stigma. Most had heard that prayer can cure HIV, and two expected to be cured. While it was common to hear messages about HIV prevention from churches or mosques, few had heard messages about living with HIV. The findings point to missed opportunities by religious organizations to support PLWHA, particularly the need to ensure that messages about HIV are not stigmatizing; share information about HIV treatment; introduce role models of PLWHA; and emphasize that prayers and medical care go hand-in-hand.

HIV/AIDS is disrupting household livelihood security in Tanzania's rural communities and contributing to rural impoverishment by claiming the lives of the most productive young adults who make up the bulk of the labor force in those areas. This article presents results of a case study based on a survey of 119 households conducted in three villages of Rung'we district in Tanzania. The results reveal that households with HIV/AIDS deaths spend less on food than those without AIDS deaths, and that households with HIV and AIDS-related deaths are more likely to fall below the poverty line.

Mortality in most HIV-infected populations has declined but yet remains high among those with barriers to accessing antiretroviral (ARV) therapy. Sustained ARV treatment significantly reduces the risk of death among the homeless.

Patients aged 18 years or older were offered rapid HIV tests and specimens were tested using the rapid Single Use Diagnostic System for HIV-1. Out of 1372, thirty-seven were confirmed as HIV positive, one of the HIV-positive participants died and the remaining 36 went to their first clinic appointment.

Preventable opportunistic infections have been found to cause not only short-term mortality in HIV-1 disease, but also seem to have a major impact on chronic mortality. The relationship of the opportunistic infections, HIV-1 RNA, and CD4 cell counts to chronic mortality was studied. Statistically significant effect modification was seen between preventable opportunistic infections and CD4 cell count.

We apply aggregate demographic analysis and computer microsimulation to project the number of older Thais who will lose children to AIDS during their own lifetimes and to assess their involvement with ill children through caregiving and coresidence. Parental bereavements from AIDS are predicted to peak at around 80, 000 per year between 2003 and 2007. Despite an HIV prevalence of only 2%, 13% of Thais who were over age 50 as of 1995 are likely to experience the loss of at least one adult child to AIDS, and 12% of them will lose multiple children. The chance of losing an adult child during one's lifetime will be 70% higher than if there were no AIDS epidemic.

HIV-1-related morbidity was studied in adults in Abidjan, Cote d'Ivoire, with emphasis on baseline CD4(super.+) cell count. Among symptomatic, ambulatory HIV-infected adults seen at urban community health centers , the overall probability of death at 1 year was 20%, and almost entirely restricted to patients in whom the CD4(super.+) cell count was less than 200/mm(super.3) at baseline. The probability of remaining free from an episode of HIV-related morbidity was 61% for patients with baseline CD4(super.+) cell counts greater than or equal to 200/mm(super.3). Those in the study had access to free, early access to care. Other data are included.

The use of highly active antiretroviral therapy (HAART) in Taiwan has cut the mortality rate from AIDS by more than 50%. HAART has been provided free of charge to many AIDS patients since 1997.

Declines in mortality rates in AIDS patients are probably a result of aggressive treatment with various drug combinations. Researchers analyzed mortality rates among 1,255 AIDS patients between 1994 and 1997. Death rates dropped from 29.4 per 100 person-years in 1995 to 8.8 per 100 person-years in 1997. The rates of certain opportunistic infections also dropped during this period. Combination drug therapy, especially when protease inhibitors were used, was associated with greater reductions in mortality.

This paper seeks to establish the strength of association between contemporary tuberculosis (TB) in England and Wales and several potential aetiological factors. It presents an ecological analysis of standardised annual TB mortality rates for the 403 local authority districts between 1982 and 1992, disaggregated by age and sex. Social, demographic and ethnicity measures from the 1981 and 1991 censuses and standardised annual AIDS-related mortality rates for young men are used to calculate Poisson regression models. A strong association was found between all TB mortality groups and overcrowding at the household level. For women, no other measures improved the explanatory power of the models. In multiple regressions, both poverty and AIDS-related mortality explained additional variation in the model for younger men. The link between ethnicity and tuberculosis notifications was not reflected in this analysis of mortality. For all groups no evidence of a positive relationship with ethnicity was found, once overcrowding had been accounted for. The significance of household as opposed to district level crowding suggests that prolonged contact is required for disease transmission. Regression analysis indicates that it is the overcrowding and poverty among ethnic populations that is significant for their tuberculosis mortality, The fact that the relationship between AIDS and TB is confined to the group most typical of AIDS patients provides evidence that AIDS has little influence on the level of tuberculosis mortality in the wider population. Explanations for the observed relationship include preferential certification, migration for treatment and shortcomings in health care provision. Key words - tuberculosis, overcrowding, poverty, ethnicity, AIDS, Poisson regression

Survival rates in AIDS patients have improved since the introduction of AZT, other antiviral drugs, and drugs to prevent opportunistic infections. Researchers analyzed survival rates in the 4,954 gay men enrolled in the Multicenter AIDS Cohort Study in 1984-1985. A total of 1,809 were HIV-positive at enrollment, and 432 of those who were HIV-negative seroconverted during the study. Men followed between 1985 and 1988 were considered to have received no drug treatment and those followed between 1989 and 1993 were considered to have received adequate drug treatment. In both groups, survival rates 2.5 years after diagnosis were greater in men with higher CD4 cell counts. Over 90% of those with CD4 cell counts greater than 350 were alive 3 years after diagnosis, whether or not they received treatment. Survival rates were better in the group that received drug treatment, mostly in those with CD4 counts less than 350. Among men who did not have AIDS, mortality rates were 1.6 to 2.3 times higher in those who had symptoms., Objective. - To estimate expected survival time among homosexual men infected with the human immunodeficiency virus type 1 (HIV-1) by (1)the calendar period before (1985-1988) and after (1989-1993) the widespread availability of acquired immunodeficiency syndrome (AIDS) treatments with antiretroviral and prophylactic interventions, and (2) stage of HIV disease. Design. - A prospective cohort study. A group of HIV-1-infected homosexual men were followed from July 1985 through June 1993 and evaluated every 6 months for the presence of clinical symptoms and measurement of the CD4 cell count. To measure the effectiveness of AIDS therapies in this nonrandomized study, we used 2 calendar periods as proxy measures of relative intensity of exposure to antiretroviral therapy. Stage of infection was defined by CD4 cell count and presence of HIV-related clinical symptoms or AIDS. Setting and Study Participants. - Homosexual men infected with HIV-1 from the Multicenter AIDS Cohort Study. Main Outcome Measure.-Survival time based on stage of HIV infection. Results. - The percentage of HIV-1-infected individuals free of AIDS and clinical symptoms at baseline who survived 2.5 years according to baseline CD4 cell counts of 0 to 0.100, 0.101 to 0.200, and 0.201 to 0.350x[10.sup.9]/L was 22%, 53%, and 83%, respectively, for the 1985-1988 calendar period, compared with 54%, 71%, and 91%, respectively, for men in the 1989-1993 calendar period. Among men free of AIDS with CD4 cell counts of greater than 0.350X [10.sup.9]/L, the relative hazard of mortality was 1.6 to 2.3 times higher for those with clinical symptoms compared with those free of clinical symptoms. Conclusions. - Survival of AIDS-free HIV-1-infected individuals with CD4 cell counts of less than 0.350X [10.sup.9]/L has improved since antiretroviral and HIV prophylactic treatments have become available, but the long-term prognosis remains poor.

Extended survival time for HIV patients whose CD4 cell counts have dropped to a level of 200 is probably due to advances in the prevention of Pneumocystis carinii pneumonia (PCP). PCP is a lung infection that can be fatal in people whose immune function is suppressed. A total of 761 homosexual and bisexual men were studied from the time of AIDS diagnosis and from the time their CD4 counts reached 200. From Oct 1983 to Nov 1986 the median survival time from a CD4 count of 200 was 28.4 months. The same figure increased to 40.1 from Nov 1986 to Nov 1988 and decreased to 38.1 from Nov 1988 to Feb 1993. The most dramatic increase was for patients diagnosed with PCP, whose survival time increased 9.7 months while HIV patients without PCP experienced a slight decrease. Such evidence suggests that improved prevention of PCP combined with antiretroviral therapy has been more effective in extending survival time than antiretroviral therapy alone., Background.--During the first decade since the recognition of the acquired immunodeficiency syndrome (AIDS), new therapies have been introduced and the frequency of clinical manifestations has changed. The impact of these changes on AIDS survival, however, has not been well characterized. Design.--A prospective cohort study of the outcomes of human immunodeficiency virus (HIV) infection. Setting.--Homosexual and bisexual men residing in San Francisco, Calif, recruited in 1983 and 1984 for two prospective studies and followed up for more than 9 years with clinical examinations. Participants.--A total of 761 HIV-positive homosexual and bisexual men. Main Outcome Measures.--Survival time from a CD4 lymphocyte count at 0.20x [10.sup.9]/L (200/[mu]L) and from a clinical AIDS diagnosis to death. Results.--Median survival time from a CD4 lymphocyte count at 0.20 x [10.sup.9]/L increased from 28.4 months in the October 1983 to November 1986 period to 40.1 months in the November 1986 to November 1988 period and is estimated at 38.1 months in the November 1988 to February 1993 period. Patients diagnosed with Pneumocystis carinii pneumonia (PCP) accounted for most of this increase with a gain in median survival time of 9.7 months (P=.0009), compared with a nonsignificant decline in the survival time of those patients without a PCP diagnosis. Multivariate analysis showed that rate of CD4 lymphocyte loss (P

Objectives. This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. Methods. AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32 513 persons with AIDS who died. Results. HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. Conclusions. Physicians and other health care professionals sbould realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals., Physicians and other healthcare professionals should realize the importance of correctly documenting HIV-related mortality on death certificates so that such data can be used in allocating healthcare resources for HIV-infected persons. A recent study has evaluated the relation between 11 health departments with AIDS case reports for 32,513 AIDS patients who died. The causes of death of persons with AIDS are described and the completeness of reporting of HIV or AIDS on the death certificates of persons with AIDS is assessed. HIV/AIDS was found to be the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987, the year specific coding procedures were implemented for HIV/AIDS. Most underlying causes fell within the AIDS case definition, including Pneumocystis carinii pneumonia, pneumonia, infections outside the AIDS case definition and drug abuse. Physicians and other healthcare professionals should realize the importance of correctly documenting HIV-related mortality on death certificates so that such data can be used in allocating healthcare resources for HIV-infected persons.

Objective. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health care usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). Methods. Sixteen health departments collected death certificates for 55 186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. Results. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men, Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). Conclusions. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support., There has been a rise in the number of AIDS deaths that occur at home or in hospices since 1983, which enables AIDS patients to receive improved social support while, at the same time, lowering medical costs. Death locations among AIDS patients were monitored to measure health care usage patterns and terminal health care. The percentage of deaths at hospitals resulting from AIDS shrank from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths took place at home or in hospices and nursing homes. These trends may indicate changes in hospital use for end-stage HIV infection. Geographic differences were found to be significant, as were rural and urban settings.

Objective. This study summarizes the evidence concerning the association of Black and White race with acquired immunodeficiency syndrome (AIDS) survival time. Methods. English-language articles measuring survival time with AIDS for Black and White persons were reviewed. Each article was assigned to one of three groups based on the method of subject accrual. Results. Of the nine eligible studies identified, five studies had inclusive methods of accruing study subjects, and four of these five showed decreased survival time among Black persons. In the studies with more restrictive accrual methods, survival time for Blacks was not decreased. Conclusions. Although the published studies vary in their results, this variation appears to be systematic according to the method of accruing study subjects. If the accrual method serves to minimimize socioeconomic differences between Blacks and Whites, there is no difference in survival time by race. However, if a more inclusive method is used, a significant decrease in AIDS survival time is observed among Blacks. This analysis suggests that, in some studies, race may function as a marker for socioconomic factors and/or access to health care and that AIDS patients in the lowest socioeconomic or access group have significantly shorter survival times., AIDS patients in the lowest socioeconomic groups may have considerably lower survival rates than others, according to nine English language studies that measured survival times of AIDS-afflicted blacks and whites. Each article was assigned to one of three groups on the basis of subject accrual. Of nine studies identified, five had inclusive methods of accruing study subjects, and four of the five showed a shorter survival time among blacks. Studies that used more restrictive accrual methods did not show a decrease in survival time for blacks. Although the results of the published studies varied, the variation appeared to be systematic, based on the method of accruing study subjects. When the accrual method used minimized the socioeconomic differences between blacks and whites, there was no difference between the races. However, if a more inclusive method was used, there was a significant decline in AIDS survival time among blacks.

Deaths associated with tuberculosis have paralleled the rise of the AIDS epidemic. Data from the National Center for Health Statistics were analyzed for deaths with tuberculosis between 1980 and 1990 and/or deaths with AIDS between 1987 and 1990. In 1980, which was near the beginning of the AIDS epidemic, deaths with tuberculosis peaked among those aged 70 to 74. By 1985, there had been a decline in deaths with tuberculosis among those aged 50 to 79 and a slight increase among those aged 20 to 44. By 1990, there had been a significant increase in the deaths with tuberculosis among those aged 20 to 44, so that deaths with tuberculosis peaked among those aged 20 to 44 and those aged 70 to 74. In 1990, the proportions of tuberculosis deaths with AIDS among those aged 20 to 49 were 59% of whites, 49.5% of blacks and 65.1% of Hispanics. Death with tuberculosis among those aged 20 to 49 increased 362% between 1982 and 1990 in the five states with the highest rates of AIDS., Objective.--To describe and analyze recent changes in tuberculosis mortality in the United States during the acquired immunodeficiency syndrome (AIDS) epidemic. Design.--We used National Center for Health Statistics multiple-cause mortality data and analyzed deaths with tuberculosis (1980 through 1990) and/or AIDS (1987 through 1990) as an underlying or associated cause. We also categorized the 50 states and the District of Columbia into high (five states), medium (23 states), and low (23 states) AIDS incidence groups and then compared the groups&apos; rates of death with tuberculosis during the period 1980 through 1990. Study Population.--Residents of the United States who died in the period 1980 through 1990. Main Outcome Measures.--Death certificates indicating AIDS and/or tuberculosis. Results.--A bimodal age distribution of persons dying with tuberculosis has emerged concurrent with the AIDS epidemic. A new peak spanning the ages 20 to 49 years accompanies the preexisting peak in the elderly. In 1990, 54.2% (729/1344) of the deaths with tuberculosis in persons 20 to 49 years of age occurred in persons who also had AIDS listed on their death certificates. During the period 1987 through 1990, there was an increasing trend in the proportion of AIDS deaths that also had tuberculosis: 2.3% (353/15 075)in 1987, 2.5% (460/18 649)in 1988, 3.0% (738/24 607)in 1989, and 3.0% (836/27 975)in 1990 (P Conclusion.--The AIDS epidemic has significantly increased the number and rate of tuberculosis deaths in younger adults through 1990, although in this study discrimination of deaths due to tuberculosis from deaths with tuberculosis was not possible. Vigorous efforts to prevent and treat tuberculosis and AIDS are indicated to reverse the trends we have described. (JAMA. 1993;269:2865-2868)