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Tropical and subtropical dry woodlands are rich in biodiversity and carbon. Yet, many of these woodlands are under high deforestation pressure and remain weakly protected. Here, we assessed how deforestation dynamics relate to areas of woodland protection and to conservation priorities across the world's tropical dry woodlands. Specifically, we characterized different types of deforestation frontier from 2000 to 2020 and compared them to protected areas (PAs), Indigenous Peoples' lands and conservation areas for biodiversity, carbon and water. We found that global conservation priorities were always overrepresented in tropical dry woodlands compared to the rest of the globe (between 4% and 96% more than expected, depending on the type of conservation priority). Moreover, about 41% of all dry woodlands were characterized as deforestation frontiers, and these frontiers have been falling disproportionately in areas with important regional (i.e. tropical dry woodland) conservation assets. While deforestation frontiers were identified within all tropical dry woodland classes of woodland protection, they were lower than the average within protected areas coinciding with Indigenous Peoples' lands (23%), and within other PAs (28%). However, within PAs, deforestation frontiers have also been disproportionately affecting regional conservation assets. Many emerging deforestation frontiers were identified outside but close to PAs, highlighting a growing threat that the conserved areas of dry woodland will become isolated. Understanding how deforestation frontiers coincide with major types of current woodland protection can help target context-specific conservation policies and interventions to tropical dry woodland conservation assets (e.g. PAs in which deforestation is rampant require stronger enforcement, inactive deforestation frontiers could benefit from restoration). Our analyses also identify recurring patterns that can be used to test the transferability of governance ap

Agricultural expansion drives biodiversity loss globally, but impact assessments are biased towards recent time periods. This can lead to a gross underestimation of species declines in response to habitat loss, especially when species declines are gradual and occur over long time periods. Using Cold War spy satellite images (Corona), we show that a grassland keystone species, the bobak marmot (Marmota bobak), continues to respond to agricultural expansion that happened more than 50 years ago. Although burrow densities of the bobak marmot today are highest in croplands, densities declined most strongly in areas that were persistently used as croplands since the 1960s. This response to historical agricultural conversion spans roughly eight marmot generations and suggests the longest recorded response of a mammal species to agricultural expansion. We also found evidence for remarkable philopatry: nearly half of all burrows retained their exact location since the 1960s, and this was most pronounced in grasslands. Our results stress the need for farsighted decisions, because contemporary land management will affect biodiversity decades into the future. Finally, our work pioneers the use of Corona historical Cold War spy satellite imagery for ecology. This vastly underused global remote sensing resource provides a unique opportunity to expand the time horizon of broad-scale ecological studies.

Habitat destruction and overexploitation are the main threats to biodiversity and where they co‐occur, their combined impact is often larger than their individual one. Yet, detailed knowledge of the spatial footprints of these threats is lacking, including where they overlap and how they change over time. These knowledge gaps are real barriers for effective conservation planning. Here, we develop a novel approach to reconstruct the individual and combined footprints of both threats over time. We combine satellite‐based land‐cover change maps, habitat suitability models and hunting pressure models to demonstrate our approach for the community of larger mammals (48 species > 1 kg) across the 1.1 million km2 Gran Chaco region, a global deforestation hotspot covering parts of Argentina, Bolivia and Paraguay. This provides three key insights. First, we find that the footprints of habitat destruction and hunting pressure expanded considerably between 1985 and 2015, across ~40% of the entire Chaco – twice the area affected by deforestation. Second, both threats increasingly acted together within the ranges of larger mammals in the Chaco (17% increase on average, ± 20% SD, cumulative increase of co‐occurring threats across 465 000 km2), suggesting large synergistic effects. Conversely, core areas of high‐quality habitats declined on average by 38%. Third, we identified remaining priority areas for conservation in the northern and central Chaco, many of which are outside the protected area network. We also identify hotspots of high threat impacts in central Paraguay and northern Argentina, providing a spatial template for threat‐specific conservation action. Overall, our findings suggest increasing synergistic effects between habitat destruction and hunting pressure in the Chaco, a situation likely common in many tropical deforestation frontiers. Our work highlights how threats can be traced in space and time to understand their individual and combined impact, even in

Trade agreements could help to protect human rights, critical ecosystems, and the climate—but only if sustainability becomes a cornerstone of international trade. The EU-Mercosur trade agreement fails to meet our three tenets of sustainable trade agreements: (1) inclusion of local communities, (2) transparency mechanisms to trace commodities and provide open-access information, and (3) enforcement to legally uphold sustainability commitments.

Aim Large and ecologically functioning steppe complexes have been lost historically across the globe, but recent land‐use changes may allow the reversal of this trend in some regions. We aimed to develop and map indicators of changing human influence using satellite imagery and historical maps, and to use these indicators to identify areas for broad‐scale steppe rewilding. Location Eurasian steppes of Kazakhstan. Methods We mapped decreasing human influence indicated by cropland abandonment, declining grazing pressure and rural outmigration in the steppes of northern Kazakhstan. We did this by processing ~5,500 Landsat scenes to map changes in cropland between 1990 and 2015, and by digitizing Soviet topographic maps and examining recent high‐resolution satellite imagery to assess the degree of abandonment of >2,000 settlements and >1,300 livestock stations. We combined this information into a human influence index (HI), mapped changes in HI to highlight where rewilding might take place and assessed how this affected the connectivity of steppe habitat. Results Across our study area, about 6.2 million ha of cropland were abandoned (30.5%), 14% of all settlements were fully and 81% partly abandoned, and 76% of livestock stations were completely dismantled between 1990 and 2015, suggesting substantially decreasing human pressure across vast areas. This resulted in increased connectivity of steppe habitat. Main conclusions The steppes of Eurasia are experiencing massively declining human influence, suggesting large‐scale passive rewilding is taking place. Many of these areas are now important for the connectivity of the wider steppe landscape and can provide habitat for endangered megafauna such as the critically endangered saiga antelope. Yet, this window of opportunity may soon close, as recultivation of abandoned cropland is gaining momentum. Our aggregate human influence index captures key components of rewilding and can help to devise strategies for fo

BACKGROUNDRapid global change is creating fundamental challenges for the persistence of natural ecosystems and their biodiversity. Conservation efforts aimed at the protection of landscapes have had mixed success, and there is an increasing awareness that the long-term protection of biodiversity requires inclusion of flexible restoration along with protection. Rewilding is one such approach that has been both promoted and criticized in recent years. Proponents emphasize the potential of rewilding to tap opportunities for restoration while creating benefits for both ecosystems and societies. Critics discuss the lack of a consistent definition of rewilding and insufficient knowledge about its potential outcomes. Other criticisms arise from the mistaken notion that rewilding actions are planned without considering societal acceptability and benefits. Here, we present a framework for rewilding actions that can serve as a guideline for researchers and managers. The framework is applicable to a variety of rewilding approaches, ranging from passive to trophic rewilding, and aims to promote beneficial interactions between society and nature.ADVANCESThe concept of rewilding has evolved from its initial emphasis on protecting large, connected areas for large carnivore conservation to a process-oriented, dynamic approach. On the basis of concepts from resilience and complexity theory of social-ecological systems, we identify trophic complexity, stochastic disturbances, and dispersal as three critical components of natural ecosystem dynamics. We propose that the restoration of these processes, and their interactions, can lead to increased self-sustainability of ecosystems and should be at the core of rewilding actions. Building on these concepts, we develop a framework to design and evaluate rewilding plans. Alongside ecological restoration goals, our framework emphasizes people’s perceptions and experiences of wildness and the regulating and material contributions from restori

Land system archetypes are unique patterns of land-use intensity within prevailing environmental and socio-economic conditions that occur repeatedly across the terrestrial surface of the earth [1].

Changes in land systems generate many sustainability challenges. Identifying more sustainable land-use alternatives requires solid theoretical foundations on the causes of land-use/cover changes. Land system science is a maturing field that has produced a wealth of methodological innovations and empirical observations on land cover and land-use change, from patterns and processes to causes. We take stock of this knowledge by reviewing and synthesizing the theories that explain the causal mechanisms of land-use change, including systemic linkages between distant land-use changes, with a focus on agriculture and forestry processes. We first review theories explaining changes in land-use extent, such as agricultural expansion, deforestation, frontier development, and land abandonment, and changes in land-use intensity, such as agricultural intensification and disintensification. We then synthesize theories of higher-level land system change processes, focusing on: (i) land-use spillovers, including land sparing and rebound effects with intensification, leakage, indirect land-use change, and land-use displacement, and (ii) land-use transitions, defined as structural non-linear changes in land systems, including forest transitions. Theories focusing on the causes of land system changes span theoretically and epistemologically disparate knowledge domains and build from deductive, abductive, and inductive approaches. A grand, integrated theory of land system change remains elusive. Yet, we show that middle-range theories - defined here as contextual generalizations that describe chains of causal mechanisms explaining a well-bounded range of phenomena, as well as the conditions that trigger, enable, or prevent these causal chains -, provide a path towards generalized knowledge of land systems. This knowledge can support progress towards sustainable social-ecological systems.

Changes in land systems generate many sustainability challenges. Identifying more sustainable land-use alternatives requires solid theoretical foundations on the causes of land-use/cover changes. Land system science is a maturing field that has produced a wealth of methodological innovations and empirical observations on landcover and land-use change, from patterns and processes to causes. We take stock of this knowledge by reviewing and synthesizing the theories that explain the causal mechanisms of land-use change, including systemic linkages between distant land-use changes, with a focus on agriculture and forestry processes. We first review theories explaining changes in land-use extent, such as agricultural expansion, deforestation, frontier development, and land abandonment, and changes in land-use intensity, such as agricultural intensification and disintensification. We then synthesize theories of higher-level land system change processes, focusing on: (i) land-use spillovers, including land sparing and rebound effects with intensification, leakage, indirect land-use change, and land-use displacement, and (ii) land-use transitions, defined as structural non-linear changes in land systems, including forest transitions. Theories focusing on the causes of land system changes span theoretically and epistemologically disparate knowledge domains and build from deductive, abductive, and inductive approaches. A grand, integrated theory of land system change remains elusive. Yet, we show that middle-range theories – defined here as contextual generalizations that describe chains of causal mechanisms explaining a well-bounded range of phenomena, as well as the conditions that trigger, enable, or prevent these causal chains –, provide a path towards generalized knowledge of land systems. This knowledge can support progress towards sustainable social- ecological systems.

ObjectivesWe investigated the trend in usage of post-exposure prophylaxis (PEP) after HIV-1 risk exposure and evaluated PEP prescription decision making of physicians according to guidelines. MethodsAll PEP consultations from January 2014 to December 2016 in patients presenting at the University Hospital of Cologne (Germany) were retrospectively analysed. HIV risk contacts included sexual and occupational exposure. The European AIDS Clinical Society (EACS) Guidelines for HIV PEP (version 9.0, 2017) were used for assessment. ResultsA total of 649 patients presented at the emergency department (ED) or the clinic for infectious diseases (IDC) for PEP consultations. A continuous increase in the number of PEP requests was recorded: 189 in 2014, 208 in 2015 and 252 in 2016. PEP consultations in men who have sex with men (MSM) showed a remarkable increase in 2016 (2014, n = 96; 2015, n = 101; 2016, n = 152). Decisions taken by physicians with a specialization in infectious diseases (n = 547) included 61 (11%) guideline-discordant prescriptions [2014: 14% (n = 22); 2015: 9% (n = 16); 2016: 11% (n = 23)]. Among these, sexual exposure accounted for 45 (74%) cases, including 15 cases of nonconsensual sex, while occupational exposure accounted for 14 (23%) cases and other exposure two cases (3%). The main reason for guideline-discordant PEP prescriptions was emotional stress of the patient (n = 37/61). ConclusionsPEP prescriptions are increasing and decision making is influenced by patients' emotional stress, but PEP prescriptions should be strictly administered according to risk assessment.

Knowledge of the spatial distribution of agricultural abandonment following the collapse of the Soviet Union is highly uncertain. To help improve this situation, we have developed a new map of arable and abandoned land for 2010 at a 10 arc-second resolution. We have fused together existing land cover and land use maps at different temporal and spatial scales for the former Soviet Union (fSU) using a training data set collected from visual interpretation of very high resolution (VHR) imagery. We have also collected an independent validation data set to assess the map accuracy. The overall accuracies of the map by region and country, i.e. Caucasus, Belarus, Kazakhstan, Republic of Moldova, Russian Federation and Ukraine, are 90±2%, 84±2%, 92±1%, 78±3%, 95±1%, 83±2%, respectively. This new product can be used for numerous applications including the modelling of biogeochemical cycles, land-use modelling, the assessment of trade-offs between ecosystem services and land-use potentials (e.g., agricultural production), among others.

© 2018 Elsevier Ltd Changes in land systems generate many sustainability challenges. Identifying more sustainable land-use alternatives requires solid theoretical foundations on the causes of land-use/cover changes. Land system science is a maturing field that has produced a wealth of methodological innovations and empirical observations on land-cover and land-use change, from patterns and processes to causes. We take stock of this knowledge by reviewing and synthesizing the theories that explain the causal mechanisms of land-use change, including systemic linkages between distant land-use changes, with a focus on agriculture and forestry processes. We first review theories explaining changes in land-use extent, such as agricultural expansion, deforestation, frontier development, and land abandonment, and changes in land-use intensity, such as agricultural intensification and disintensification. We then synthesize theories of higher-level land system change processes, focusing on: (i) land-use spillovers, including land sparing and rebound effects with intensification, leakage, indirect land-use change, and land-use displacement, and (ii) land-use transitions, defined as structural non-linear changes in land systems, including forest transitions. Theories focusing on the causes of land system changes span theoretically and epistemologically disparate knowledge domains and build from deductive, abductive, and inductive approaches. A grand, integrated theory of land system change remains elusive. Yet, we show that middle-range theories – defined here as contextual generalizations that describe chains of causal mechanisms explaining a well-bounded range of phenomena, as well as the conditions that trigger, enable, or prevent these causal chains –, provide a path towards generalized knowledge of land systems. This knowledge can support progress towards sustainable social-ecological systems.

In the light of daunting global sustainability challenges such as climate change, biodiversity loss and food security, improving our understanding of the complex dynamics of the Earth system is crucial. However, large knowledge gaps related to the effects of land management persist, in particular those human-induced changes in terrestrial ecosystems that do not result in land-cover conversions. Here, we review the current state of knowledge of ten common land management activities for their biogeochemical and biophysical impacts, the level of process understanding and data availability. Our review shows that ca. one-tenth of the ice-free land surface is under intense human management, half under medium and one-fifth under extensive management. Based on our review, we cluster these ten management activities into three groups: (i) management activities for which data sets are available, and for which a good knowledge base exists (cropland harvest and irrigation); (ii) management activities for which sufficient knowledge on biogeochemical and biophysical effects exists but robust global data sets are lacking (forest harvest, tree species selection, grazing and mowing harvest, N fertilization); and (iii) land management practices with severe data gaps concomitant with an unsatisfactory level of process understanding (crop species selection, artificial wetland drainage, tillage and fire management and crop residue management, an element of crop harvest). Although we identify multiple impediments to progress, we conclude that the current status of process understanding and data availability is sufficient to advance with incorporating management in, for example, Earth system or dynamic vegetation models in order to provide a systematic assessment of their role in the Earth system. This review contributes to a strategic prioritization of research efforts across multiple disciplines, including land system research, ecological research and Earth system modelling.

AimLand-use change is considered a major threat to biodiversity. Species–area relationships (SARs), which are often used to assess biodiversity changes, assume that land use leads to the loss of natural habitats. Yet, in regions with long land-use histories, such as Europe, many species have persisted in, or even depend on, landscapes heavily influenced by land use (i.e., countryside landscapes). Here, we develop a SAR model that considers the conservation value of such landscapes, and we assess how land use affects plant-species richness at broad spatial scales.LocationCountries in the European Union (EU-27).MethodsWe first predicted species richness at a 50 × 50 km resolution using a biome-specific SAR and used these predictions as a baseline estimate for (semi-)natural vegetation. Then, we parameterized a countryside SAR (sensu Pereira & Daily, 2006) with habitat affinities derived from a meta-analysis. We estimated changes in species richness as the difference in predictions between the two SAR models.ResultsAt a 50 × 50 km resolution, predicted species richness has increased by up to 184 species due to land use in 73% of all cells across Europe compared to the (semi-)natural baseline. However, our model also highlights regions with dramatic species losses (in 25% of cells, losses of up to 900 species) due to an unfavourable combination of land-use changes. Averaged across all cells, we predict a loss of 26 plant species (SD = 119, median = 49).Main conclusionsAdopting the countryside SAR model to broader spatial scales overcomes the unrealistic assumptions of previous approaches about generally negative effects of land use. Our approach predicts how local-scale land-use effects translate to biodiversity changes at broader geographic scales. Thus, it allows land-use scenarios being studied in relation to their trade-offs with biodiversity and can be used to target c

In light of daunting global sustainability challenges such as climate change, biodiversity loss and food security, improving our understanding of the complex dynamics of the Earth system is crucial. However, large knowledge gaps related to the effects of land management persist, in particular those human-induced changes in terrestrial ecosystems that do not result in land cover conversions. Here we review the current state of knowledge of ten common land management activities for their biogeochemical and biophysical impacts, the level of process-understanding and data availability. Our review shows that ca. one tenth of the ice free land surface is under intense human management, half under medium and one fifth under extensive management. Based on our review, we cluster these ten management activities into three groups: (1) management activities for which datasets are available, and for which a good knowledge base exists (cropland harvest and irrigation); (2) management activities for which sufficient knowledge on biogeochemical and biophysical effects exists but robust global datasets are lacking (forest harvest, tree species selection, grazing and mowing harvest, N-fertilization); and (3) land management practices with severe data gaps concomitant with an unsatisfactory level of process understanding (crop species selection, artificial wetland drainage, tillage and fire management and crop residue management, an element of crop harvest). Although we identify multiple impediments to progress, we conclude that the current status of process understanding and data availability is sufficient to advance with incorporating management in e.g. Earth System or Dynamic Vegetation models in order to provide a systematic assessment of their role in the Earth system. This review contributes to a strategic prioritization of research efforts across multiple disciplines, including land system research, ecological research and Earth system modelling.

ObjectivesPEPDar compared the tolerability and safety of ritonavir-boosted darunavir (DRV/r)-based post-exposure prophylaxis (PEP) with the tolerability and safety of standard of care (SOC). The primary endpoint was the early discontinuation rate among the per-protocol population. MethodsPEPDar was an open-label, randomized, multicentre, prospective, noninferiority safety study. Subjects were stratified by type of event (occupational vs. nonoccupational, i.e. sexual) and were randomized to receive DRV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) or SOC PEP. Twenty-two private or university HIV clinics in Germany participated. Subjects were 18 years old and had documented or potential HIV exposure and indication for HIV PEP. They initiated PEP not later than 72 h after the event and were HIV negative. ResultsA total of 324 subjects were screened, the per-protocol population was 305, and 273 subjects completed the study. One hundred and fifty-five subjects received DRV/r-based PEP and 150 subjects received ritonavir-boosted lopinavir (LPV/r)-based PEP for 28-30 days; 298 subjects also received tenofovir/emtricitabine. The early discontinuation rate in the DRV/r arm was 6.5% compared with 10.0% in the SOC arm (P = 0.243). Adverse drug reactions (ADRs) were reported in 68% of DRV/r subjects and 75% of SOC subjects (P = 0.169). Fewer DRV/r subjects (16.1%) had at least one grade 2 or 3 ADR compared with SOC subjects (29.3%) (P = 0.006). All grades of diarrhoea, nausea, and sleep disorders were significantly less frequent with DRV/r, while headache was significantly more frequent. No HIV seroconversion was reported during follow-up. ConclusionsNoninferiority of DRV/r to SOC was demonstrated. DRV/r should be included as a standard component of recommended regimens in PEP guidelines.

Comprehensive maps that characterize the variation in agricultural landscapes across Europe are lacking. In this paper we present a new Europe-wide, spatially-explicit typology and inventory of the diversity in composition, spatial structure and management intensity of European agricultural landscapes. Agricultural landscape types were characterized at a 1 km

Species–area relationships (SARs) provide an avenue to model patterns of species richness and have recently been shown to vary substantially across regions of different climate, vegetation, and land cover. Given that a large proportion of the globe has been converted to agriculture, and considering the large variety in agricultural management practices, a key question is whether global SARs vary across gradients of agricultural intensity.We developed SARs for mammals that account for geographic variation in biomes, land cover and a range of land-use intensity indicators representing inputs (e.g. fertilizer, irrigation), outputs (e.g. yields) and system-level measures of intensity (e.g. human appropriation of net primary productivity – HANPP). We systematically compared the resulting SARs in terms of their predictive ability.Our global SAR with a universal slope was significantly improved by the inclusion of any one of the three variable types: biomes, land cover, and land-use intensity. The latter, in the form of human appropriation of net primary productivity (HANPP), performed as well as biomes and land-cover in predicting species richness. Other land-use intensity indicators had a lower predictive ability.Our main finding that land-use intensity performs as well as biomes and land cover in predicting species richness emphasizes that human factors are on a par with environmental factors in predicting global patterns of biodiversity. While our broad-scale study cannot establish causality, human activity is known to drive species richness at a local scale, and our findings suggest that this may hold true at a global scale. The ability of land-use intensity to explain variation in SARs at a global scale had not previously been assessed. Our study suggests that the inclusion of land-use intensity in SAR models allows us to better predict and understand species richness patterns.

Objectives Syphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the characteristics of patients including sexual behaviour, rates of concurrent sexually transmitted infections (STI) and type of treatment given. Methods Patients were recruited from Ireland, Poland and Germany. Data gathered included demographics, method of syphilis acquisition, stage of syphilis infection, HIV status, nadir and current CD4 counts and HIV viral suppression rates. Data were then subanalysed into HIV-positive and HIV-negative groups. Results Of 175 patients recruited, 68% were HIV-positive and 86.3% were men who have sex with men. Most HIV-positive patients presented with secondary syphilis (55.7% vs 13.2%) (p=0.0001) while the majority of HIV-negative patients had primary syphilis noted at the time of recruitment (47.2% vs18.9%, p=0.0002). Approximately half of all patients had a HIV RNA viral load <40 copies/mL (55%). Previous syphilis infection occurred more frequently in HIV-positive than HIV-negative patients (p=0.0001). Concurrent STIs at the time of syphilis diagnosis were found in 26.8%, of whom 31 (25.4%) were HIV-positive (p=0.64). HIV-positive patients received doxycycline more frequently than their HIV-negative counterparts (33.6% vs 1.9%, p=0.0001) while HIV-negative patients were treated with long-acting penicillin in 88.7% of cases vs 58% of HIV-positive patients (p=0.0002). Conclusions A 40% rate of unsuppressed viraemia, high levels of STIs and varying treatment regimens represent a public health risk for Europe, suggesting the model of sexual healthcare delivery in HIV-positive patients requires further evaluation.

AimLand-use change is the single biggest cause of biodiversity loss. With a rising demand for resources, understanding how and where agriculture threatens biodiversity is of increasing importance. Agricultural expansion has received much attention, but where high agricultural land-use intensity (LUI) threatens biodiversity remains unclear. We address this knowledge gap with two main research questions: (1) Where do global patterns of LUI coincide with the spatial distribution of biodiversity? (2) Where are regions of potential conflict between different aspects of high LUI and high biodiversity?LocationGlobal.MethodsWe overlaid thirteen LUI metrics with endemism richness, a range size-weighted species richness indicator, for mammals, birds and amphibians. We then used local indicators of spatial association to delineate statistically significant (P < 0.05) areas of high and low LUI associated with biodiversity.ResultsPatterns of LUI are heterogeneously distributed in areas of high endemism richness, thus discouraging the use of a single metric to represent LUI. Many regions where high LUI and high endemism richness coincide, for example in South America, China and Eastern Africa, are not within currently recognized biodiversity hotspots. Regions of currently low LUI and high endemism richness, found in many parts of Mesoamerica, Eastern Africa and Southeast Asia, may be at risk as intensification accelerates.Main conclusionsWe provide a global view of the geographic patterns of LUI and its concordance with endemism richness, shedding light on regions where highly intensive agriculture and unique biodiversity coincide. Past assessments of land-use impacts on biodiversity have either disregarded LUI or included a single metric to measure it. This study demonstrates that such omission can substantially underestimate biodiversity threat. A wider spectrum of relevant LUI metrics needs to be considered when balancing agricultural production and bi

Causes of death in human immunodeficiency virus (HIV)-infected subjects have changed in countries with high resources over the last several years. Acquired immunodeficiency syndrome (AIDS)-related diseases have become less prevalent, whereas deaths due to non-AIDS causes are increasing. The aim of the present study was to analyse causes of death in the Cologne-Bonn cohort. Causes of death from the Cologne-Bonn cohort between 2004 and 2010 were systematically recorded using the CoDe algorithm (The Coding Causes of Death in HIV Project). In 3,165 patients followed from 2004 to 2010, 182 deaths occurred (5.7 %, 153 males, 29 females). The median age at the time of death was 47 years (range 24-85 years). The most frequent causes of death were AIDS-defining events (n = 60, 33 %), with non-Hodgkin lymphoma (NHL) (n = 29, 16 %) and infections (n = 20, 11 %) being the leading entities in this category. Non-AIDS malignancies accounted for 16 % (n = 29), non-HIV-related infections for 10 % (n = 18), cardiovascular diseases for 7 % (n = 14), suicide or accident for 4 % (n = 7) and liver diseases for 3 % (n = 5) of deaths (unknown n = 47, 26 %). Although the majority of patients (92.5 %) was on antiretroviral therapy (ART), only 50 % were virologically suppressed (HIV-RNA < 50 copies/mL) and 44 % had a decreased CD4+ count (< 200/mu L) at their last visit before death. One-third of the causes of death in our cohort between 2004 and 2010 was AIDS-related. Since most of these deaths occur with severe immune suppression, they can possibly be prevented by the early diagnosis and treatment of HIV infection. Care providers must be aware of an increased risk for a broad range of diseases in HIV-infected patients and should apply appropriate preventive measures.