CAUSES OF DEATH OF HIV-INFECTED PERSONS IN OTTAWA, ONTARIO, 1984-1995

Background: Acquired immunodeficiency syndrome (AIDS) has become a lea ding cause of death of young men in the United States. With the introd uction of prophylaxes and antiretrovirals for opportunistic infection, there have been significant changes in the clinical history of human immunodeficiency virus (HIV) infection. Objective: To determine the ca use of death of the patients followed up by our clinic from 1984 to 19 95. Methods: A critical chart review was performed on the records of a ll patients affiliated with the Ottawa General Hospital HIV/AIDS Clini c, Ottawa, Ontario, who died between 1984 and July 15, 1995, Data rega rding the cause of death, last CD4 T-lymphocyte cell count before deat h, medication use at time of death, and location and year of death wer e collected. Data were analyzed for 1984 through 1988, 1989 through 19 91, and 1992 through 1995, corresponding to the evolution of HIV-relat ed medical care. Results: The median CD4 T-lymphocyte cell count at de ath has declined. Pneumocystis carinii pneumonia has decreased signifi cantly as cause of death (28.6%-3.8%, P<.001). No other specific attri butable terminal illness has decreased in frequency during 11 years. T he wasting illnesses, particularly HIV wasting syndrome (3.6%-13.7%, P =.04), and untreatable illnesses have increased in frequency as causes of death. Patients are increasingly likely to die at home (0%-25%, P< .001) and less likely to die in hospital (54%-35%, P<.001). Conclusion s: The HIV-infected persons are dying with more advanced HIV immunosup pression. Advances in P. carinii pneumonia prophylaxis and treatment h ave had a dramatic effect on the cause of death of HIV-infected person s. Improved prophylaxis and treatment for non-P carinii pneumonia oppo rtunistic infections and malignancies and HIV wasting syndrome are req uired.