Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort

INTRODUCTION:

Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013.

MATERIALS AND METHODS:

We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models.

MORTALITY RESULTS:

182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)].

SURVIVAL RESULTS:

Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male and <200 CD4 at diagnosis versus ≥500 CD4. 

Factors associated with non-HIV-related causes of death include: ageing and heterosexual female versus MSM. Factors associated with external causes of death were IDU male and heterosexual male versus MSM.

Below:  Survival curves according to age, origin, educational level, transmission category, CD4, and anti-HCV antibodies.

Full article at:   http://goo.gl/BA6YNr

By:   Garriga C1,2, García de Olalla P1,3, Miró JM4, Ocaña I5, Knobel H6, Barberá MJ5, Humet V7, Domingo P8, Gatell JM4, Ribera E5, Gurguí M8, Marco A7, Caylà JA1,3; Barcelona HIV/AIDS working group.

• 1Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
• 2Spanish Field Epidemiology Training Programme, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
• 3CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
• 4Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
• 5Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
• 6Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain.
• 7Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain.
• 8Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
• PLoS One. 2015 Dec 30;10(12):e0145701. doi: 10.1371/journal.pone.0145701

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Homicide in Chile: Trends 2000 – 2012

Background

Homicide, an external cause of morbidity and mortality, caused 473,000 deaths worldwide in 2012, a rate of 6.2 per 100,000 inhabitants. The aim of this study was to describe homicide mortality trends in Chile between 2000 and 2012 by year, gender, age group, geographic distribution (by zone and by region) and type of homicide.

Methods

This was a population-based study. Data for homicide mortality in Chile between 2000 and 2012 were used and they were provided by the Chilean Ministry of Health’s Department of Statistics and Health Information (DEIS) and PAHO/WHO. The homicide mortality rates were calculated per 100,000 inhabitants. The study variables were year, geographic distribution, gender, age group and type of homicide. The annual percentage change (APC) of the rates was analyzed, and a logarithm of the rates by year and region was fitted by applying linear regression models. In addition, relative risks (RR) were calculated. 95 % confidence intervals were considered in all the analyses.

Results

The average yearly rate of homicide (HMR) in Chile (2000–2012) was 4.9. The rates were higher in men (8.7) than in women (1.1), with a RR of 8.2. The rates were higher in the country’s central zone (5.0), increasing in recent years in the southern zone, with a significant positive APC of 1.1 %. The Aisén Region had the highest rate (7.6), although Antofagasta was the region with the most significant APC (3.1 %). The highest rate (9.2) was verified in the 25 to 39 age group. The highest rate (5.5) was recorded in 2005. The most frequent type of homicide was assault with an object (44.8 %).

Conclusions

Although the homicide rates are higher in the southern zone of the country, the northern zone is showing a tendency to increase, becoming an even more serious problem, which not only affects those directly involved, but society as a whole.

Below:  Homicide mortality rate per 100,000 population by zone

Full article at: http://goo.gl/IY9VoZ

By:   Tamara Otzen^1234*, Antonio Sanhueza⁵⁶, Carlos Manterola¹⁷, Tamara Melnik⁴ and Monica Hetz⁸

¹Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile

²Escuela de Psicología, Universidad Autónoma de Chile, Temuco, Chile

³Universidad Científica del Sur, Lima, Peru

⁴Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil

⁵Departamento de Matemática y Estadísticas, Universidad de La Frontera, Temuco, Chile

⁶Pan American Health Organization/Regional Office of the World Health Organization, Washington, USA

⁷Departamento de Cirugía, Universidad de La Frontera, Temuco, Chile

⁸Psychology, Catholic University of Temuco, Temuco, Chile

 

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Role of Liver Transplantation in Human Immunodeficiency Virus Positive Patients

End-stage liver disease (ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus (HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus (HCV) infection, drug-induced hepatotoxicity related to combined anti-retro-viral therapy, alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. 

It is therefore, anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. 

However, HIV-HCV co-infection transplant outcomes remain suboptimal due to recurrence. In this article, we review the key challenges faced by this patient cohort in the pre- and post-transplant period.

Below:  Causes of death amongst human immunodeficiency virus-positive patients. Adapted from Smith et al[5]. AIDS: Acquired immunodeficiency syndrome; CVD: Cardio-vascular disease.

Full article at:  http://goo.gl/Gywxy2

By:  Deepak Joshi and Kosh Agarwal

Deepak Joshi, Kosh Agarwal, Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS London, United Kingdom

Author contributions: Joshi D and Agarwal K reviewed the literature and wrote the manuscript.

Correspondence to: Dr. Deepak Joshi, Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS London, United Kingdom. ten.shn@ihsoj.d

Telephone: +44-203-2999000

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Causes of Death among Detainees: A Statistical Study on the Casework of the Forensic Medicine Institute in Cluj-Napoca During the Period 2000-2014

BACKGROUND AND AIMS:

The detainees' right to healthcare is granted by laws, in accordance with EU directives and recommendations to which our country has consented. Prison population is a particularly vulnerable and marginalized group characterized by mortality rates different from the general population. This study aims at providing a picture of the causes of death, quality of healthcare and measures needed to reduce the number of in-prison deaths, including legal medicine expertise in view of sentence postponement/interruption.

METHODS:

The present paper is based on the statistical analysis of in-prison deaths casework recorded at the Forensic Medicine Institute of Cluj-Napoca and provided by territorially subordinated counties forensic services. The data collected cover over 15 years (2000-2014), a period long enough for significant retrospective statistical analysis.

RESULTS:

The total number of deaths among the inmates was 113, the majority of male sex (110). Distribution by age groups shows a greater incidence among inmates aged 50 to 59 years (32 cases, 28.31%), followed by those in their 40s' (30 cases, 26.54%) and 30s' (25 cases, 22.12%). The most frequent pathological causes of death were cardiovascular (53 cases) followed by tumors (26 cases) and infectious diseases. A significant number of deaths were due to violent causes (14 cases-12,38%).

CONCLUSIONS:

Special problems are raised by the high number of deaths among prisoners, especially at a young age, while the high frequency of violent deaths from self- or non-self-inflicted traumatic causes requires supervision, monitoring and continuous analysis. Despite recent improvements, healthcare in prisons still poses some problems, mainly regarding diagnosis and treatment of heart diseases, neurosurgery and cancer.

Below:  Distribution of annual North-West prison deaths in the timeframe 2000–2014

Below:  Distribution of deaths in North-West prisons

Below:  Distribution of inmate deaths in North-West prisons according to age groups

Below:  Cause of death in North-West prisons 2000–2014

Below:  Cardiovascular conditions resulting in in-prison deaths

Below:  Tumor location in in-prison deaths due to cancer

Full article at:  http://goo.gl/CcPNnf

By:  Gherman C1, Chiroban O1.

• 1Department of Community Medicine, Forensic Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

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Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010–2011

Although AIDS-related deaths have had significant economic and social impact following an increased disease burden internationally, few studies have evaluated the cause of AIDS-related deaths among patients with AIDS on combination anti-retroviral therapy (cART) in China. This study examines the causes of death among AIDS-patients in China and uses a methodology to increase data accuracy compared to the previous studies on AIDS-related mortality in China, that have taken the reported cause of death in the National HIV Registry at face-value.

Death certificates/medical records were examined and a cross-sectional survey was conducted in three provinces to verify the causes of death among AIDS patients who died between January 1, 2010 and June 30, 2011. Chi-square analysis was conducted to examine the categorical variables by causes of death and by ART status. Univariate and multivariate logistic regression were used to evaluate factors associated with AIDS-related death versus non-AIDS related death.

This study used a sample of 1,109 subjects. The average age at death was 44.5 years. AIDS-related deaths were significantly higher than non-AIDS and injury-related deaths. In the sample, 41.9% (465/1109) were deceased within a year of HIV diagnosis and 52.7% (584/1109) of the deceased AIDS patients were not on cART. For AIDS-related deaths (n = 798), statistically significant factors included CD4 count <200 cells/mm³ at the time of cART initiation, ART naïve and age <39 years.

For the AIDS patients that were deceased, only those who initiated cART while at a CD4 count ≥200 cells/mm3 were less likely to die from AIDS-related causes compared to those who didn’t initiate ART at all.

Below:  Time from diagnosis to death (months), among 1109 deceased patients (across different causes of death)

Below:  Time from diagnosis to death (months), across different cART groups, by cause of death (AIDS, non-AIDS, all causes). (A) Time from diagnosis to death (months), among 798 AIDS-related deaths; (B) Time from diagnosis to death (months), among 216 non-AIDS related deaths; (C) Time from diagnosis to death (months), among 1109 deceased patients; cART group was divided into ART naïve, ART initiation CD4 <200 cells/mm3 and ART initiation CD4 ≥200 cells/mm3.

Full article at: http://goo.gl/neB3Wj

By:

Liyan Wang, Lin Ge, Lu Wang, Wei Guo, Qianqian Qin, Zhengwei Ding, Yan Cui

Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

Jamie P. Morano

University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, USF Medicine International, Tampa, Florida, United States of America

Kaveh Khoshnood

Yale School of Public Health, New Haven, Connecticut, United States of America

Dingyong Sun

Henan Center for AIDS/STD Control and Prevention, Henan Center for Disease Control and Prevention, Henan, China

Xiaoyan Liu

Jiangsu Center for AIDS/STD Control and Prevention, Jiangsu Center for Disease Control and Prevention, Jiangsu, China

Hongbing Luo

Yunnan Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Yunnan, China

Jonas Tillman

Division of Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

  

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Local Perceptions of Causes of Death in Rural South Africa: A Comparison of Perceived and Verbal Autopsy Causes of Death

Below:  Concordance (log-log scale) between CSMF determined by VA and respondent reports, in relation to the line of equivalence, for 6,721 deaths in the Agincourt HDSS, South Africa. CSMF=cause-specific mortality fractions; VA= verbal autopsy.

Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15–49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA.

Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants’ reported causes of death.

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