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Advanced antiretroviral therapy has prolonged the lives of both men and women infected with the human immunodeficiency virus (HIV). In fact, 20 percent of deaths among HIV-infected women are due to causes other than AIDS, according to the Women's Interagency HIV Study (WIHS), which is jointly funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention.
Factors independently associated with non-AIDS-related deaths included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age. Doctors need to pay attention to treatable conditions such as hepatitis C, depression, and drug and tobacco use to further decrease deaths among HIV-infected women, according to lead author Mardge H. Cohen, M.D., of Cook County Hospital, and her colleagues.
The researchers classified the cause of death of women with, or at risk of, HIV infection enrolled in the WIHS from 1994 to 1995, as AIDS- or non-AIDS related death based on data from death certificates and CD4 cell count (an indicator of immune system function). Among the 414 HIV-infected women who died by April 2000, 294 deaths were AIDS-related, 91 were non-AIDS-related, and 29 deaths were from indeterminate causes. The non-AIDS causes of death included liver failure (21); drug overdose (18); non-AIDS malignancies (13); cardiac disease (11); murder, suicide, or accident (11); and gastrointestinal causes (10).
All-cause and AIDS-related mortality rates for HIV-infected women decreased markedly from October 1995 through April 1997, the period of introduction of combination antiretroviral therapy, and has continued to decrease. All-cause deaths declined an average of 26 percent per year, and AIDS-related mortality declined by an average of 39 percent per year among HIV-infected women. In contrast, non-AIDS-related deaths among an extremely vulnerable group of women remained stable (10 percent average annual decrease).
See "Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy," by Dr. Cohen, Audrey L. French, M.D., Lorie Benning, M.S., and others, in the August 1, 2002, American Journal of Medicine 113, pp. 91-98.
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