Trends in Diseases Reported on Death Certificates that Mentioned HIV Infection, USA, 1996 - 2005

Background: Widespread use of highly active antiretroviral therapy after 1995 reduced deaths among persons with HIV. We examined trends during 1996–2005 in diseases reported on death certificates that mentioned HIV infection.

Methods: We analyzed multiple-cause mortality data compiled by the National Center for Health Statistics from all US death certificates with any mention of HIV infection to determine the annual percentages of deaths with various diseases, standardized to the age, sex, and racial distribution of the US population in 2000.

Results: Deaths reported with HIV infection decreased from 35,340 in 1996 to 14,376 in 2005. Standardized percentages of death certificates reporting AIDS-defining opportunistic infections also decreased: pneumocytosis (6.3% to 5.3%), non-tuberculous mycobacteriosis (5.5% to 1.8%), cytomegalovirus (5.7% to 1.0%). For AIDS-defining cancers, Non-Hodgkin's lymphoma rose from 4.8% in 1996 to 6.4% in 1997 and declined to 5.0% in 2005, while Kaposi's sarcoma declined from 3.7% in 1996 to 1.7% in 2005. The percentage of deaths reported with diseases not specifically attributable to HIV increased from 1996 to 2005: non-AIDS defining cancers combined (2.7% to 7.7%), liver disease (5.8% to 13.3%), kidney disease (7.9% to 11.8%), heart disease (4.9% to 9.6%). The median age at death increased from 39 years to 46 years.

Conclusion: Deaths among persons with HIV decreased over 50% during the analysis period. The percentage of deaths reported with HIV-attributable diseases decreased, while the percentage reported with other diseases increased. Consequently, diseases not attributable to HIV may need increased attention in the clinical management of HIV-infected persons.