HIV Remains a Top-10 Cause of Death for Some Populations, Despite Overall Mortality Drops

The most recent data from the CDC show a 36.6% decrease in overall mortality among individuals living with HIV. Despite this progress, however, the virus remains a leading cause of death among certain races and ethnicities, according to study results published in Morbidity and Mortality Weekly Report.

“Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population,” the authors of this report noted, “yet HIV remains among the 10 leading causes of death among certain populations.” This is despite HIV-related deaths being preventable.

They used National HIV Surveillance System data to determine age-adjusted death rates per 1000 individuals with diagnosed HIV, who were at least 13 years old, from 2010 through 2017. Temporal changes in overall deaths also were assessed for 2010 through 2018. Demographics, transmission category, and US Census region were considered in these determinations. Data were analyzed through December 2019.

This investigation found, in addition to the 36.6% decrease (from 19.4 to 12.3 per 1000) previously mentioned, a 48.4% drop in HIV-related deaths (from 9.1 to 4.7 per 1000) between 2010 and 2017 and an 8.6% decrease (from 9.3 to 8.5 per 1000) in deaths not related to HIV.

“Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non–HIV-related,” the authors pointed out. “Age-adjusted rates per 1,000 PWDH were calculated using the U.S. 2000 standard population.”

Data also show that total deaths among persons with diagnosed HIV dropped by 7.5% from 2010 to 2018: from 16,742 to 15,483. In fact, all regions, genders, ages, races/ethnicities, and transmission category groups saw declines in HIV-related deaths between 2010 and 2017.

There were also closures in racial disparities. For example, by 2017 between Hispanic/Latino and White individuals, the absolute rate difference disparity (ARDD) measure for HIV-related deaths came in at zero (3.9 per 1000), while the ARDD between Black and White individuals decreased by 66.0%.

In addition, men who had sex with other men saw fewer HIV-related deaths per 1000 (3.9) compared with other transmission categories, such as injection drug users (6.2), male-to-male sexual contact and injection drug use (6.1), and heterosexual contact (5.8). For women, those who acquired HIV through heterosexual contact saw just 4.6 deaths per 1000 vs 7.7 for injection drug users and 7.0 for other (ie, hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified).

Mortality rates per 1000 individuals, however, remained elevated among the following races and ethnicities, genders, age ranges, and regions:

• Individuals with a multiple-race background: 7.0
• Blacks/African Americans: 5.6
• South region: 6.0
• Midwest region: 4.4
• Females: 5.4
• Males: 4.5
• Transgender males: 10.7
• Persons 55 years and older: 8.4
• Persons 45 to 55 years: 5.1

“Deaths among persons with HIV have decreased, and by 2018 had surpassed the 2020 national target,” the authors concluded. “However, differences in HIV-related death rates still exist for multiple populations. Diagnosing HIV infection early, treating it promptly, and maintaining access to high-quality care and treatment over a lifetime can improve life expectancy and reduce differences in rates of deaths across all populations.”

Reference

Bosh KA, Johnson S, Hernandez AL, et al. Vital signs: deaths among persons with diagnosed HIV infection, United States, 2010-2018. MMWR Morb Mortal Wkly Rep. 2020;69(46):1717-1724. doi:10.15585/mmwr.mm6946a1