To examine changes in the causes of death and mortality in women with human immunodeficiency
virus (HIV) infection in the era of combination antiretroviral therapy.
Among women with, or at risk of, HIV infection, who were enrolled in a national study
from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired
immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates
and the CD4 count. Poisson regression models were used to estimate death rates and
to determine the risk factors for AIDS and non-AIDS deaths.
Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had
died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available
for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women,
deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n =
29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16),
non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or
accident (n = 10). All-cause mortality declined an average of 26% per year (P = 0.03)
and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related
mortality remained stable (10% average annual decrease, P = 0.73). Factors that were
independently associated with non-AIDS-related mortality included depression, history
of injection drug use with hepatitis C infection, cigarette smoking, and age.
A substantial minority (20%) of deaths among women with HIV was due to causes other
than AIDS. Our data suggest that to decrease mortality further among HIV-infected
women, attention must be paid to treatable conditions, such as hepatitis C, depression,
and drug and tobacco use.