Changing spectrum of mortality due to human immunodeficiency virus: Analysis of 260 deaths during 1995-1999

We analyzed the deaths in an outpatient human immunodeficiency virus (HIV) care clinic at University Hospitals in Cleveland from January 1995 through December 1999. The number of annual deaths decreased progressively, from 11 2 in 1995 to 32 in 1999. The median final CD4(+) cell count before death in creased progressively from 10 cells/muL in 1995 to 90 cells/muL in 1999 (P < .01); 20%-25% of patients who died from 1997 through 1999 had plasma HIV RNA levels below detection limits. From 1995 through 1998, deaths due to in fection, to end- stage acquired immune deficiency syndrome, and to malignan cies decreased, whereas the proportion of deaths due to end-organ failures and of uncertain relationship to HIV infection increased. The spectrum of m ortality in HIV disease has changed recently; although opportunistic infect ions cause death less frequently, deaths are occurring in people who have c ontrol of HIV replication and with some preservation of immune function. Th ese observations underscore the need to monitor the etiologies of HIV-assoc iated mortality and to better our understanding of the relationships among immune defenses, treatment-related toxicities, and end-organ failure in pat ients with HIV disease.