Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jul 2;100(26):e26507.
doi: 10.1097/MD.0000000000026507.

Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection

Li Wei Ang  1 , Matthias Paul Han Sim Toh  1   2 , Chen Seong Wong  1   2   3 , Irving Charles Boudville  1 , Sophia Archuleta  1   2   4 , Vernon Jian Ming Lee  2   5 , Yee Sin Leo  1   2   3   6 , Angela Chow  1   2   3   6
Affiliations
Observational Study

Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection

Li Wei Ang et al. Medicine (Baltimore). .

Abstract

We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Distribution of clinical and immunological features of HIV/AIDS cases with late diagnosis (LD) by year of diagnosis, 2012 to 2016. LD = late diagnosis, nLD = non-late diagnosis.
Figure 2
Figure 2
Annual all-cause mortality rate per 100 person-years among HIV/AIDS cases, 2012 to 2017. (A) Overall. (B) Late diagnosis and non-late diagnosis. LD = late diagnosis, nLD = non-late diagnosis.
Figure 3
Figure 3
Kaplan–Meier survival estimates of HIV/AIDS cases stratified by stage of HIV infection at diagnosis. The number at risk since diagnosis is shown in the table below the figure. LD = late diagnosis, nLD = non-late diagnosis.
Figure 4
Figure 4
Distribution of causes of death of HIV/AIDS cases diagnosed from 2012 to 2016 according to time interval between HIV diagnosis and death, stratified by stage of HIV infection at diagnosis. LD = late diagnosis, nLD = non-late diagnosis.
Figure 5
Figure 5
Annual mortality rate per 100 person-years by HIV/AIDS-related and non-HIV/AIDS related causes of death, 2012 to 2017.
See this image and copyright information in PMC

References

    1. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005;39:446–53. - PubMed
    1. Fisher M. Late diagnosis of HIV infection: major consequences and missed opportunities. Curr Opin Infect Dis 2008;21:01–3. - PubMed
    1. Girardi E, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr 2007;46: suppl: S3–8. - PubMed
    1. Simmons RD, Ciancio BC, Kall MM, Rice BD, Delpech VC. Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer. HIV Med 2013;14:596–604. - PubMed
    1. Grangeiro A, Escuder MM, Menezes PR, Alencar R, Ayres de Castilho E. Late entry into HIV care: estimated impact on AIDS mortality rates in Brazil, 2003–2006. PLoS One 2011;6:e14585. - PMC - PubMed

Publication types

MeSH terms