Risk of Non-AIDS-Related Mortality May Exceed Risk of AIDS-Related Mortality Among Individuals Enrolling Into Care With CD4+ Counts Greater Than 200 Cells/mm3

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Abstract
Objective: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART). Methods: Competing-risk methods were used to determine the cumulative AIDS-related and non-AIDS-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study. Results: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4+ count ≤200 cells/mm3 in the HAART era. For those with a CD4+ count >200 cells/mm3, however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities. Conclusions: HAART has reduced mortality rates among HIV-infected individuals, but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.