Background Our combined human immunodeficiency virus (HIV) and hematology/oncology clinic includes 600 HIV+ patients, 60 of whom died in the last decade. Our intimate doctor-to-patient care allows for increased precision when determining the underlying causes of patient mortality. Large cohort studies such as the ASD project may not allow for such detail because of dependence on medical records or death certificates to determine causes of death.
Objective To determine variances in death between a single provider VMMC patient dataset and a larger public health cohort during the highly active antiretroviral therapy (HAART) era.
Methods We contrasted two data sets. The first was the Seattle-King County ASD dataset (N = 4,721), which recorded 351 patient deaths during 1996-2004. The second was the 1996-2006 VMMC HIV mortality cohort (N = 600). We used Χ2 and Fisher exact tests for our statistical analysis.
Results Sixty VMMC patients died. The median time between HIV diagnosis to death was 11 years (range 0-22). Thirty-nine (65%) VMMC patients died from nonopportunistic illness (OI), 18 (30%) from OI, and 3 (5%) from both. The most common OI was wasting. The most common non-OIs were malignancy, liver failure, and pneumonia. Eleven of 60 patients (18%) died despite a nondetectable HIV viral load (NDVL), and 351 ASD patients died. The median time between HIV diagnosis and death was 6 years (0-18). Three hundred one ASD patients had a known cause of death. One hundred thirty-five (45%) died from non-OI, 105 (35%) from OI, and 61 (20%) from both non-OI and OI. The most common OI was mycobacteria. The most common non-OIs were liver failure and pneumonia. Thirty-five of 351 patients (10%) died despite a NDVL. ASD was more likely to have an OI as a cause of death (p = .032).
Conclusions Males and those with substance abuse, mental illness, poor/moderate adherence, and a C2/C3 AIDS designation were heavily represented in both data sets. The VMMC patients had a longer interval between HIV diagnosis and death than those in the Seattle/King County ASD project. Liver failure and pneumonia were the dominant non-OI in both data sets. Malignancy as a cause of death was overrepresented in the VMMC data set due to the concentration of such patients in a hematology/oncology practice. ASD had a greater proportion of patients without a known cause of death, suggesting greater difficulty designating the underlying cause of death when patients are not intimately known.
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