Changes in Mortality Related to Human Immunodeficiency Virus Infection: Comparative Analysis of Inpatient Deaths

We conducted a retrospective chart review of human immunodeficiency virus (HIV)–infected patients who died in 1995 and in 1999–2000. We found an increase in the proportion of patients who died from an illness that was not related to acquired immunodeficiency syndrome (AIDS). Although there was a decrease in the prevalence of AIDS-defining illnesses, 185 % of patients died with CD4 counts of!200 cells/mL. The leading cause of death was Pneumocystis carinii pneumonia (PCP). Nonadherence to therapy and new diagnosis of HIV infection were the leading reasons why patients were not receiving antiretroviral therapy. The leading causes of non–AIDS-related deaths in 1999–2000 were non–AIDS-defining infections and end-stage liver dis-ease. At our hospital, PCP remains an important cause of death in the highly active antiretroviral therapy (HAART) era, possibly because 150 % of HIV-infected patients who died were not receiving HAART. AIDS-defining illnesses continue to be a major cause of mortality in the HAART era in populations where access to care and adherence to HAART is limited. Since the introduction of HAART, mortality due to AIDS-defining illnesses has decreased [1–5]. The spe-cific causes of mortality in the HIV-infected population continue to be investigated. A study from Cleveland