Causes of Death in People Living With Human Immunodeficiency Virus in Türkiye: A Multicentre Retrospective Study

Abstract

Purpose Effective antiretroviral therapy has significantly reduced mortality rates among people living with HIV (PWH) and has altered the distribution of causes of death. We aimed to investigate trends in causes of death among PWH over time. Methods We investigated all reported deaths in the Turkish Clinical Microbiology and Infectious Diseases Society HIV Cohort. Causes of death were categorized and analyzed across four time periods: 1997-2006, 2007-2014, 2015-2019, and 2020-2023. Factors associated with HIV/AIDS-related causes of death were compared to other causes of death. Results A total of 9,334 PWH were followed, of which 414 deaths (4.4%) occurred, including 44 (11.6%) among individuals assigned female at birth. The most common causes of death were AIDS-related illnesses (57.7%), non-AIDS-related cancers (11.1%), and cardiovascular diseases (9.9%). Among causes of death, the rate of AIDS-related diseases has declined over the years (p<0.001). Rates of non-AIDS-related cancers (p=0.013) and non-AIDS-related infections (p=0.008) have increased, and deaths due to comorbid conditions such as cardiovascular diseases have remained stable (p=0.193). In multivariate analysis, AIDS-related deaths were significantly associated with an increased risk in individuals who had an AIDS-defining illness at baseline. The rate of AIDS-related deaths declined in later periods compared to 1997-2006. AIDS-related deaths decreased with older age at HIV diagnosis. The rate of AIDS-related deaths was less frequent among men who have sex with men, smokers, and ex-smokers, individuals on antiretroviral therapy, those with higher CD4 counts, and individuals with comorbid diseases. Conclusions Among all deaths, AIDS-related deaths have declined. In contrast, the proportion of deaths attributed to non-AIDS-related cancers has increased, and the mortality rate from cardiovascular disease has remained unchanged over the years. Therefore, it is crucial to implement interventions that address comorbid conditions, particularly by enhancing the management of cardiovascular disease and cancer.