Genotypic drug resistance and cause of death in HIV-infected persons who died in 1999

We analyzed the relationship between viral drug resistance and causes of de ath in 29 HIV-1-infected patients who had been followed in an HIV-outpatien t clinic and died in 1999. Six patients (21%) died with plasma HIV-RNA leve ls < 1000 copies/ml. Seven (24%) died with wild-type (WT) virus in plasma, 6 (21%) had reverse transcriptase (RT) mutations only, 10 (34%) had multidr ug-resistant (MDR) virus. The causes of death were not differently distribu ted among these groups, however, 8 of 16 patients (50%) with resistant viru ses died of end-organ failure versus 2 of 7 patients (29%) with WT virus. S eventeen of 32 patients (53%) were thought by their physicians to be noncom pliant with prescribed therapy, Major resistance mutations to antiretrovira l drugs were present in viruses from at least 55% of our HIV-1-infected pat ients who died in 1999. Nonetheless, deaths also occurred among patients wi th well-controlled HIV infection and among patients with WT virus in plasma . Infections related to incomplete immune restoration, inability to maintai n suppressive antiretroviral drug levels, and end-organ failures all contri bute to mortalities in the era of highly active antiretroviral therapy.