Cargando…

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

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 d...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, Yoonjung, Kim, Shin-Woo, Chang, Hyun-Ha, Kwon, Ki Tae, Bae, Sohyun, Hwang, Soyoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590652/
https://www.ncbi.nlm.nih.gov/pubmed/33107229
http://dx.doi.org/10.3346/jkms.2020.35.e355
_version_ 1783600845918568448
author Kim, Yoonjung
Kim, Shin-Woo
Chang, Hyun-Ha
Kwon, Ki Tae
Bae, Sohyun
Hwang, Soyoon
author_facet Kim, Yoonjung
Kim, Shin-Woo
Chang, Hyun-Ha
Kwon, Ki Tae
Bae, Sohyun
Hwang, Soyoon
author_sort Kim, Yoonjung
collection PubMed
description 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/mm(3) and CD4 ≥ 200 cells/mm(3) groups. CONCLUSION: Being diagnosed with CD4 < 200 cells/mm(3) at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm(3) 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.
format Online
Article
Text
id pubmed-7590652
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher The Korean Academy of Medical Sciences
record_format MEDLINE/PubMed
spelling pubmed-75906522020-10-30 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, Yoonjung Kim, Shin-Woo Chang, Hyun-Ha Kwon, Ki Tae Bae, Sohyun Hwang, Soyoon J Korean Med Sci Original Article 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/mm(3) and CD4 ≥ 200 cells/mm(3) groups. CONCLUSION: Being diagnosed with CD4 < 200 cells/mm(3) at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm(3) 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. The Korean Academy of Medical Sciences 2020-09-28 /pmc/articles/PMC7590652/ /pubmed/33107229 http://dx.doi.org/10.3346/jkms.2020.35.e355 Text en © 2020 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Yoonjung
Kim, Shin-Woo
Chang, Hyun-Ha
Kwon, Ki Tae
Bae, Sohyun
Hwang, Soyoon
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590652/
https://www.ncbi.nlm.nih.gov/pubmed/33107229
http://dx.doi.org/10.3346/jkms.2020.35.e355
work_keys_str_mv AT kimyoonjung trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy
AT kimshinwoo trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy
AT changhyunha trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy
AT kwonkitae trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy
AT baesohyun trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy
AT hwangsoyoon trendsofcauseofdeathamonghumanimmunodeficiencyviruspatientsandtheimpactoflowcd4countsondiagnosistodeatharetrospectivecohortstudy