S Croxford1, R F Miller2, F A Post3, R Harding4, S B Lucas5, J Figueroa1,6, I Harrison6, V C Delpech1, S Dhoot7, A K Sullivan1,7. 1. National Infection Service, Public Health England, London, UK. 2. Central and North West London NHS Foundation Trust, Mortimer Market Centre, London, UK. 3. King's College Hospital NHS Foundation Trust, London, UK. 4. Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK. 5. Guy's & St Thomas' NHS Foundation Trust, London, UK. 6. NHS England London, London, UK. 7. Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Abstract
OBJECTIVES: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. METHODS: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. RESULTS: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non-AIDS-related malignancies and AIDS-defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non-injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty-nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/μL, and 24% had a viral load ≥ 200 HIV-1 RNA copies/mL. Thirty-six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two-thirds of expected deaths had a prior end-of-life care discussion documented. CONCLUSIONS: In 2016, most deaths were attributable to non-AIDS-related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.
OBJECTIVES: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. METHODS: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. RESULTS: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non-AIDS-related malignancies and AIDS-defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non-injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty-nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/μL, and 24% had a viral load ≥ 200 HIV-1 RNA copies/mL. Thirty-six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two-thirds of expected deaths had a prior end-of-life care discussion documented. CONCLUSIONS: In 2016, most deaths were attributable to non-AIDS-related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.
Authors: Sophia M Rein; Fiona C Lampe; Clinton Chaloner; Adam Stafford; Alison J Rodger; Margaret A Johnson; Jeffrey McDonnell; Fiona Burns; Sara Madge; Alec Miners; Lorraine Sherr; Simon Collins; Andrew Speakman; Andrew N Phillips; Colette J Smith Journal: BMC Infect Dis Date: 2021-04-29 Impact factor: 3.090
Authors: Alison E Brown; Sara E Croxford; Sophie Nash; Jameel Khawam; Peter Kirwan; Meaghan Kall; Daniel Bradshaw; Caroline Sabin; Robert F Miller; Frank A Post; Richard Harding; Simon Collins; Laura Waters; David Asboe; David R Chadwick; Valerie Delpech; Ann K Sullivan Journal: HIV Med Date: 2021-09-15 Impact factor: 3.094