Causes and characteristics of death among HIV-1 infected patients with immunovirologic response to antiretroviral treatment

Introduction To analyse the causes of death among HIV-infected adults in France in the year 2000. Methods Based on data from a national survey, our study describes and analyses the causes and characteristics of patients with immunological and virological response (CD4>200/mm(3), ARN-HIV<500 copies/mL), who died during antiretroviral treatment. Results Among a total of 964 deaths registered, data on 864 cases were available for analysis. One hundred forty-nine patients (17%) were immunovirological responders. The underlying causes of death were non AIDS-defining malignancies for 36 (24%), mainly due to lung cancer (16 cases), hepatocarcinoma (7) and ano-rectal carcinoma (3), AIDS for 22 (15%), mainly due to Non Hodgkin Lymphoma (10 cases) and uterine cancer (3), cardiovascular diseases for 22 (15%), post hepatitis C hepatic failure for 16 (11%), suicide for 16 (11%), and bacterial infections for 14 (9%). When comparing characteristics of death in the 149 responders versus the 715 other patients, the responders were significantly more frequently: coinfected by HCV+ (45 vs. 33%), injected drug addicts (40 vs. 27%), alcoholics (38 vs. 28%), and dyslipidemics (19 vs. 11%). In 2000, around 20% of registered deaths of HIV patients in France had occurred among good immunovirological responders. Conclusion To further reduce mortality among such efficiently treated patients, attention must be focused on treatable conditions such as hepatitis C, dyslipidemia and on the prevention of malignancies such as lung cancer and cervical or ano-rectal carcinoma.