Trends in Mortality From Human Immunodeficiency Virus Infection, 1984-2016: An Autopsy-Based Study
| Autor: | Amy Rapkiewicz, Cameron Morales, Kelly Hu, Robert S. Holzman, Sobia Nizami |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Adult Male Pediatrics medicine.medical_specialty Human immunodeficiency virus (HIV) Autopsy HIV Infections medicine.disease_cause Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Antiretroviral Therapy Highly Active Neoplasms medicine Humans Mortality Mortality trends Epidemics Retrospective Studies Acquired Immunodeficiency Syndrome Models Statistical business.industry Incidence (epidemiology) Incidence Retrospective cohort study General Medicine Middle Aged medicine.disease Antiretroviral therapy Medical Laboratory Technology 030104 developmental biology Logistic Models 030220 oncology & carcinogenesis Female New York City business |
| Zdroj: | Archives of pathologylaboratory medicine. 144(5) |
| ISSN: | 1543-2165 |
| Popis: | Context.—With increasing use and efficacy of antiretroviral therapy for human immunodeficiency virus (HIV) infection, deaths from acquired immunodeficiency syndrome (AIDS)–defining conditions have decreased.Objective.—To examine trends in the cause of death of HIV-infected patients who underwent autopsy at a major New York City hospital from 1984 to 2016, a period including the major epochs of the AIDS epidemic.Design.—Retrospective review of autopsy records and charts with modeling of trends by logistic regression using polynomial models.Results.—We identified 252 autopsies in adult patients with AIDS (by 1982 definition) or HIV infection. Prior to widespread use of highly active antiretroviral therapy, in 1984–1995, on average 13 autopsies per year were done. Post–highly active antiretroviral therapy, the average number of autopsies declined to 4.5 per year. The fitted mean age at death was 35 years in 1984 and increased curvilinearly to 46 years (95% CI, 43–49) in 2016 (P < .001). By regression analysis, mean CD4+ T-cell count increased from 6 in 1992 to 64 in 2016 (P = .01). The proportion of AIDS-defining opportunistic infections decreased, from 79% in 1984–1987 to 41% in 2008–2011 and 29% in 2012–2016 (P = .04). The frequency of nonopportunistic infections, however, increased from 37% in 1984–1987 to 73% in 2008–2011 and 57% in 2012–2016 (P = .001). The frequency of AIDS-defining and other malignancies did not change significantly during the study period. The prevalence of atherosclerosis at autopsy rose dramatically, from 21% in 1988–1991 to 54% in 2008–2011 (P < .001).Conclusions.—Despite limitations of autopsy studies, many trends in the evolution of the HIV/AIDS epidemic are readily discernable. |
| Databáze: | OpenAIRE |
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