Trends of mortality and cause of death among HIV-infected patients in Korea, 1990-2011

Abstract

Although a decrease in acquired immunodeficiency syndrome (AIDS)-related mortality has been documented in highly active antiretroviral therapy (HAART) era, there are no published data comparing specific causes of death between pre-HAART and HAART era in Korea. Mortality and cause of death were analyzed in three treatment periods; pre-HAART (1990-1997), early-HAART (1998-2001), and late-HAART period (2002-2011). The patients were retrospectively classified according to the treatment period in which they were recruited. Although mortality rate per 100 person-year declined from 8.7 in pre-HAART to 4.9 in late-HAART period, the proportion of deaths within 3 months of initial visit to study hospital significantly increased from 15.9% in pre-HAART to 55.1% in late-HAART period (P < 0.001). Overall, 59% of deaths were attributable to AIDS-related conditions, and Pneumocystis pneumonia (PCP) was the most common cause of death (20.3%). The proportion of PCP as cause of death significantly increased from 8.7% in pre-HAART to 31.8% in late-HAART period (P < 0.001). Despite of significant improvement of survival, there was still a high risk of early death in patients presenting in HAART era, mainly due to late human immunodeficiency virus (HIV) diagnosis and late presentation to care.

Keywords: Antiretroviral Therapy; Cause of Death; HIV; Mortality.

Fig. 1

Kaplan-Meier survival plot for HIV-infected patients stratified by the treatment period in which they were recruited. Pre-HAART period (1990-1997), early-HAART period (1998-2001), and late-HAART period (2002-2011) (Generalized Wilcoxon test, χ² test value of 28.8 on 2 degree of freedom, unadjusted P < 0.001 for comparisons among each period).