People Living With HIV in New York City Still Dying From Infections, Not Just Old Age

A team of researchers has found that while people with HIV are living longer and healthier lives, they are still dying from underlying infection, not just from old age.

Using autopsy reports of 252 people who died of AIDS in New York City between 1984 and 2016, the researchers discovered that infections associated with the virus are still the leading cause of death for the patient population in the state.

Autopsy reports of patients with HIV/AIDS has played a significant role in recognizing the array of infections associated with the virus since the earliest literature of the disease.

“Autopsy reports reliably tell the whole disease story and why people are still dying from it,” said Amy Rapkiewicz, MD, associate professor in the Department of Pathology at NYU Langone, vice chair of pathology at NYU Winthrop Hospital, and senior investigator of the study, in a statement. “That is because there is often a difference between the immediately reported cause of death, such as heart attack, and the actual cause of death, whether from obesity, drug use, or HIV/AIDS.”

Thanks to the advent of antiretroviral therapy (ART)—introduced in the 1990s—the lifespan of someone living with HIV has increased drastically. According to findings from the study, the average age of death from AIDS in New York City increased from 36 years in 1984 to 54 years in 2010. But the findings also showed that among the 252 people autopsied, pneumocystis pneumonia and other infections still account for the majority of deaths.

Between 1984 and 1987, the infections accounted for 100% of deaths. Shortly after the introduction of ART, rates dropped in half, with infections accounting for 52% of deaths between 1996 and 1999. Between 2012 and 2016, infections accounted for 86% of deaths.

“Even a HIV-positive patient is immunocompromised and at increased risk of dying from pneumonia,” said Rapkiewicz.

According to Rapkiewicz, now that people living with HIV are living longer with the virus, other common coinfections, including hepatitis C infections, are beginning to emerge as causes of death. Across the 23-year period, hepatitis C infections were present in 15 patients. Notably, 3 out of the 4 autopsied patients between 2014 and 2016 died from hepatitis C cirrhosis.

One finding that the researchers could not analyze further but said could be explained by future autopsy reports is the increase in atherosclerosis. The condition was observed in 21% of those autopsied between 1988 and 1991. Between 2008 and 2011, the condition was observed in 54%.

Sobia Nizami, MD, a clinical fellow in infectious diseases at NYU Langone, and lead study investigator, said that it’s difficult to determine if the finding is a result of people living with HIV living longer, overeating, and following the sedentary lifestyles observed among non-infected people, or if it’s a long-term side effect of ART.

Reference

Nizami S, Morales C, Hu K, Holzman R, Rapkiewicz A. Trends in mortality from human immunodeficiency virus infection, 1984-2016: an autopsy-based study [published online August 28, 2019]. Arch Pathol Lab Med. doi:10.5858/arpa.2019-0144-OA.