330. Trends in Hospital Mortality Among HIV-infected Patients During the Antiretroviral Therapy Era, 1995-2011
Session: Poster Abstract Session: HIV Co-morbidities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Antiretroviral therapy (ART) has contributed to a substantial decrease in HIV associated mortality, primarily due to a decrease in AIDS related deaths. However, overall mortality remains higher among HIV-infected individuals compared to the general population. We evaluated demographic and clinical characteristics of in hospital deaths among HIV-infected patients during the ART era. 

Methods: We conducted a retrospective chart review of patients discharged from an urban teaching hospital with an ICD-9 of HIV or AIDS who died from 1/1/1995 to 12/31/2011. Using a standardized data collection tool, we abstracted demographics, comorbidities, cause of death, use of ART, HIV viral load (VL), and CD4 cell count.  Among 12,183 discharges, 406 HIV-infected patients died. The cause of death was classified as AIDS or non-AIDS related according to published definitions. The early ART era was defined as the period from 1995 to 2001 and the late ART era from 2002 to 2011. Causes of death were compared with univariate analysis and factors predicting non-AIDS deaths were identified using multivariate regression analysis. 

Results: There were 400 patients who met criteria for review. Compared to the early ART period, patients in the late ART period were older (p<0.0001), had higher CD4 counts (p<0.0001), were more likely to be on ART (p=0.0008), and had an HIV VL < 400 copies/ml at the time of death (p<0.0001). Although overall mortality declined, AIDS related deaths decreased while non-AIDS related deaths increased significantly (p<0.0001).  Compared with patients who died from AIDS related causes, patients with non-AIDS deaths were 4.5 times more likely to have liver disease (95% CI, 2.15 to 9.30) and 4.2 times more likely to have cardiovascular disease (95% CI, 1.78 to 9.89).

Conclusion: Our study demonstrates that overall mortality among hospitalized HIV-infected patients has significantly declined during the ART era. Our findings highlight the importance of early preventive primary care to reduce non-AIDS mortality with emphasis on reducing cardiovascular risk and managing hepatitis C co-infection. Future directions include review of racial and gender differences in non-AIDS mortality to identify factors contributing to an increased risk for death.

Annie Cowell, MD MPH1, Sheela Shenoi, MD, MPH2, Tassos Kyriakides, PhD3 and Lydia Barakat, MD2, (1)Yale Internal Medicine and Pediatrics Residency Program, New Haven, CT, (2)Yale University School of Medicine, New Haven, CT, (3)Yale Center for Analytical Sciences, New Haven, CT

Disclosures:

A. Cowell, None

S. Shenoi, None

T. Kyriakides, None

L. Barakat, None

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