Risk factors and causes of death in the Australian HIV Observational Database

Sexual Health ◽  
2006 ◽  
Vol 3 (2) ◽  
pp. 103 ◽  
Author(s):  
Kathy Petoumenos ◽  
Matthew G. Law ◽  
on behalf of the Australian HIV Observational Database
Keyword(s):  
Risk Factors ◽  
Cause Of Death ◽  
Antiretroviral Treatment ◽  
Causes Of Death ◽  
Cd4 Count ◽  
Infected People ◽  
Highly Active ◽  
Observational Database ◽  
Independent Risk Factors ◽  
Advanced Hiv Disease

Introduction: Mortality rates in HIV-infected people remain high in the era of highly active antiretroviral treatment (HAART). The objective of this paper was to examine causes of deaths in the Australian HIV Observational Database (AHOD) and compare risk factors for HIV-related and HIV-unrelated deaths. Methods: Data from AHOD, an observational study of people with HIV attending medical sites between 1999 and 2004, were analysed. Primary and underlying causes of death were ascertained by sites completing a standardised cause of death form. Causes of death were then coded as HIV-related or HIV-unrelated. Risk factors for HIV-related and unrelated deaths were assessed using survival analysis among patients who had a baseline and at least one follow-up CD4 and RNA measure. Results: The AHOD had enrolled 2329 patients between 1999 and 2004. During this time, a total of 105 patients died, with a crude mortality rate of 1.58 per 100 person years. Forty-two (40%) deaths were HIV-related (directly attributable to an AIDS event), 55 (52%) HIV-unrelated (all other causes), and eight had unknown cause of death. Independent risk factors for HIV-related deaths were low CD4 count and receipt of a larger number of antiretroviral treatment combinations. Among HIV-unrelated deaths, low CD4 count and older age were independent risk factors. Conclusions: In AHOD in the HAART era, mortality in people with HIV remains around 10-fold higher than in the general population. In our analyses, HIV-unrelated deaths were associated with more advanced HIV disease in a similar way to HIV-related deaths.

Risk factors for tuberculosis after highly active antiretroviral treatment (HAART) initiation among HIV patients: A systematic review

2012 ◽  
Vol 10 (55) ◽  
pp. 3561-3595
Author(s):  
Abdulhalik Workicho Bushra ◽  
Ahmed Zeynudin ◽  
Tariku Dejene ◽  
Mirkuzie Wolde ◽  
Morankar Sudhakar
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antiretroviral Treatment ◽  
Hiv Patients ◽  
Highly Active ◽  
Highly Active Antiretroviral Treatment

Longterm Survival and Associated Risk Factors in Patients with Adult-onset Idiopathic Inflammatory Myopathies and Amyopathic Dermatomyositis: Experience in a Single Institute in Japan

2011 ◽  
Vol 38 (8) ◽  
pp. 1636-1643 ◽  
Author(s):  
YOSHIOKI YAMASAKI ◽  
HIDEHIRO YAMADA ◽  
MICHIKO OHKUBO ◽  
MASAOMI YAMASAKI ◽  
KOHEI AZUMA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Therapeutic Strategy ◽  
Causes Of Death ◽  
Idiopathic Inflammatory Myopathies ◽  
Adult Onset ◽  
Inflammatory Myopathies ◽  
Skin Ulcers ◽  
Independent Risk Factors ◽  
Longterm Survival ◽  
Associated Risk Factors

Objective.To analyze clinical characteristics, survival, causes of death, and risk factors associated with mortality in patients with adult-onset idiopathic inflammatory myopathies (IIM) in Japan.Methods.We retrospectively investigated 197 patients diagnosed with adult-onset IIM at our hospital from 1984 to 2009 according to Bohan and Peter criteria for polymyositis (PM)/dermatomyositis (DM) and modified Sontheimer’s criteria for clinically amyopathic DM (ADM).Results.Survival in the whole group at 1, 5, and 10 years was 85%, 75%, and 67%, respectively. Mortality in cancer-associated myositis was the worst (25% at 5 yrs), followed by clinically ADM (61% at 5 yrs) and primary DM (77% at 5 yrs). Primary DM had significantly low survival compared to primary PM (91% at 5 yrs; p = 0.0427). Among the 53 patients who died were 6 patients with ADM (11%) and 20 patients with primary DM (38%). Interstitial lung disease (ILD) was the main cause of death in clinically ADM (71%) and primary DM (60%), most of which occurred within the first few months. Fewer patients died in primary PM (9%) and overlap myositis (13%). Independent risk factors for death were older age (HR 1.031; 95% CI 1.009–1.053) and skin ulcers (HR 3.018; 95% CI 1.340–6.796) in the whole group and ILD with mild serum creatine kinase levels (< 500 IU/l; HR 3.537; 95% CI 1.260–9.928) in primary DM.Conclusion.Survival of clinically ADM and primary DM was low, mainly due to fatal ILD, compared to primary PM. Establishing therapeutic strategy for ILD may improve the survival in our patient population.

Mortality rate and causes of death in women with self-reported musculoskeletal pain: Results from a 17-year follow-up study

2013 ◽  
Vol 4 (2) ◽  
pp. 86-92 ◽  
Author(s):  
Anne K. Nitter ◽  
Karin Ø. Forseth
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Mortality Rate ◽  
Musculoskeletal Pain ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Sleep Problems ◽  
Whole Body ◽  
Risk Of Death

AabstractIntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain is reported to be 35-53% in cross sectional studies of both genders. For many years, it has been a common opinion among medical doctors that chronic pain may indeed reduce a person’s quality of life, but not affect life expectancy. However, over the previous two decades, reports about mortality and cause of death in individuals with chronic pain have been published. So far, several studies conclude that there is an increased mortality in patients with chronic pain, but it is not clear what causes this. Increased occurrences of cardio-vascular death or cancer death have been reported in some studies, but not verified in other studies.Aims of the studyThe aims of this study were to estimate the mortality rate in females with different extent of pain, to identify potential risk factors for death and to investigate if the causes of death differ according to prior reported pain.MethodsThis is a prospective population-based study of all women between 20 and 50 years registered in Arendal, Norway, in 1989 (N = 2498 individuals). At follow-up in 2007, 2261 living females were retraced, 89 had died.All subjects received a questionnaire containing questions about chronic pain (pain ≥ 3 months duration in muscles, joints, back or the whole body) as well as 13 sub-questions about pain-modulating factors, non-specific health complaints and sleep problems, by mail in 1990, 1995 and 2007. Only subjects who answered the questionnaire in 1990 were included in the analyses. Of the deceased, 71 had answered the questionnaire in 1990.A multivariate model for cox regression analysis was used in order to clarify if chronic pain, sleep problems, feeling anxious, frightened or nervous and number of unspecific health were risk factors for death.The causes of death of 87 of the deceased individuals were obtained by linking the ID-number with the Norwegian Cause of Death Registry.ResultsThe ratio of deceased responders was 2% (14/870) among those with no pain versus 5% (57/1168) among those with chronic pain at baseline. When separating into chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8% in the different groups. Age adjusted hazard ratio for mortality rate in individuals with initially chronic pain was [HR 2.5 (CI 1.4–4.5)] compared to pain free individuals. In the multivariate analysis, having chronic pain [HR 2.1 (1.1–4.2)] and feeling anxious, frightened or nervous [HR 3.2 (1.8–5.6)] were associated with increased risk of death. There was no difference in death from cardiovascular disease or malignancies between the groups of pain free individuals vs. the group of individuals with chronic pain.ConclusionThe mortality rate was significantly higher for individuals with chronic pain compared to pain free individuals, adjusted for age. In addition, feeling anxious, frightened or nervous were risk factors for death. There was an increase in all-cause mortality.

scholarly journals Tuberculosis and lactic acidosis as causes of death in adult patients from a regional hospital in Johannesburg

2012 ◽  
Vol 4 (1) ◽  
Author(s):  
Ntambwe Malangu ◽  
Maryet Mogashoa
Keyword(s):  
Side Effects ◽  
Lactic Acidosis ◽  
South African ◽  
Cause Of Death ◽  
Antiretroviral Treatment ◽  
Causes Of Death ◽  
Regional Hospital ◽  
Adult Patients ◽  
African Countries ◽  
Collection Form

Background: Tuberculosis and adverse effects have been shown to affect both the quality of life and the survival of patients on antiretroviral treatment. This study sought to investigate the causes of death in a sample of adult HIV-infected patients on antiretroviral treatment at Thembisa Hospital, Johannesburg, South Africa. Methods: A retrospective study was conducted by examining the charts of 498 adult patients treated from January 2004 to December 2006 at the antiretroviral clinic of a regional hospital in Johannesburg. A data collection form was used to collate both sociodemographic and clinical data.Results: The majority of the patients were female (71.7%) with a mean age of 37.7 ± 11.6 years, and in the age group of 18–77 years. The greater number of the patients was South African citizens, with only 2.2% citizens of other Southern African countries. At baseline, 29.9% had been on anti-tuberculosis treatment. Most of the patients had been prescribed the regimen comprising stavudine, lamivudine, and nevirapine or efavirenz; two of them (0.4%) were on the second line regimen made of zidovudine, didanosine, and lopinavir–ritonavir. At least one side effect was documented in 82.1% of patients; the ten most documented side effects were skin rashes (62.9%), peripheral neuropathy (48.4%), headaches (38.2%), chest pain (21.9%), coughing (21.7%), anaemia (21.5%), diarrhoea (19.3%), vomiting (16.7%), dizziness (15.3%), and lactic acidosis (11.2%). A mortality rate of 3.6% was recorded during the 2-year study period. Although the cause of death was undetermined in 11.1% of patients, 50.0% and 38.9% of deaths respectively were a consequence of tuberculosis and lactic acidosis.Conclusions: In addition to tuberculosis, side effects in particular, lactic acidosis was the other main cause of death in patients treated at the study site. These findings suggest that patients on regimens containing drugs that cause lactic acidosis should be closely monitored when the first complaints suggesting lactic acidosis are reported or noticed.

Causes of Death in the Highly Active Antiretroviral (HAART) Era: A Retrospective Comparison between a Hybrid HIV and Hematology/Oncology Practice and the Adult & Adolescent Spectrum of HIV-Related Diseases (ASD) Project.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3865-3865
Author(s):  
Matthew C. Uhlenkott ◽  
Erin Kahle ◽  
Susan Buskin ◽  
Elizabeth Barash ◽  
David M. Aboulafia
Keyword(s):  
Mental Illness ◽  
Liver Failure ◽  
Median Time ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Cd4 Count ◽  
Fisher Exact Test ◽  
King County ◽  
Hiv Diagnosis ◽  
Opportunistic Illness

Abstract Background: Our practice at Virginia Mason Medical Center (VMMC) 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 HAART era. Methods: We contrasted two datasets. The first was the Seattle/King County ASD dataset (n=4721), which recorded 351 patient deaths during 1996–2004. The second was the 1996–2006 VMMC HIV mortality cohort. Abstracted data include patient demographics, causes of death, co-morbidities, treatment adherence, CDC AIDS classification, and relevant laboratory data. We used X2 and Fisher Exact test for our statistical analysis. Results: Of the 60 VMMC patients who died, 57 (95%) were male, 16 (27%) injection drug users (IDU), 50% with significant mental illness, and 44 (73%) with a C2/C3 CDC AIDS classification. Median time between HIV diagnosis to death was 11 years (range, 0–22). There were 33 (55%) patients with poor/moderate adherence. Of the 351 ASD patients who died, 301 (86%) were male, 43 (12%) IDU, 250 (71%) with significant mental illness, and 285 (81%) with a C2/C3 CDC AIDS classification. Median time between HIV diagnosis and death was 6 years (0–18). Of 92 patients for whom adherence data was collected, 69 (75%) had poor/moderate adherence. 39 (65%) VMMC patients died from non-opportunistic illness (OI), 18 (30%) from OI, and 3 (5%) from both (see table). The most common OIs were wasting, non-Hodgkin’s lymphoma, and progressive multi-focal leukoencephalopathy (PML). The most common non-OIs were malignancy, liver failure, and pneumonia. 11 of 60 patients (18%) died despite a non-detectable HIV viral load (NDVL) and median CD4+ count of 216 cells/μL (range, 16–952). 301 of 351 ASD patients had a known cause of death. 135 (45%) died from non-OI, 105 (35%) from OI, and 61 (20%) from both non-OI and OI (see table). The most common OIs were mycobacteria, dementia, and cytomegalovirus. The most common non-OIs were liver failure, pneumonia, and sepsis. 35 of 351 patients (10%) died despite a NDVL and median CD4+ count of 223 cells/μL (5–1616). Conclusions: Males and those with substance abuse, mental illness, poor/moderate adherence, and a C2/C3 AIDS designation were heavily represented in both datasets. 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-OIs in both datasets. Malignancy as a cause of death was over-represented in VMMC due to the concentration of such patients in a Hem/Onc 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. Table Outcome VMMC (N=60); N (%) ASD (N=301); N (%) p-value Opportunistic Illness (OI) 18 (30) 105 (35) No Significance Non-OI 39 (65) 135 (45) .004 Both OI & non-OI 3 (5) 61 (20) .005

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