Longitudinal trends amongst HIV-infected people in the USA – mortality at autopsy

Researchers have recently published a study elucidating trends in mortality associated with HIV infection over a period spanning 1984-2016: retrospective findings from 252 autopsy records were examined. The findings are of specific interest because the study spans the period prior to the introduction of highly active antiretroviral therapy (HAART). After the advent of HAART in 1984-1995, autopsies declined from a mean of 13 per year were done to 4.5 per year. The fitted mean age at death was 35 years in 1984 and increased curvilinearly to 46 (95% CI, 43-49) in 2016 (P < .001). Mean CD4⁺ T-cell count increased significantly and the proportion of AIDS-defining opportunistic infections decreased, from 79% in 1984-1987 to 29% in 2012-2016 (p = 0.04). The frequency of AIDS-defining and other malignancies did not change significantly during the study period. The prevalence of atherosclerosis at autopsy rose dramatically, from 21% in 1988-1991 to 54% in 2008-2011 (P < .001), suggesting that metabolic effects of the antivirals may be contributing to this issue. Details of the research can be viewed here