Time Trends in Causes of Death in People With HIV: Insights From the Swiss HIV Cohort Study
M. Weber, Jessy J. Duran Ramirez, Maxime Hentzien, Matthias Cavassini, Enos Bernasconi, Eveline Hofmann, Hansjakob Furrer, Helen Kovari, M Stöckle, Patrick Schmid, David Haerry, Dominique L. Braun, Huldrych F. Günthard, Katharina Kusejko, the Swiss HIV Cohort Study, Irène A. Abela, Karoline Aebi‐Popp, A Anagnostopoulos, Manuel Battegay, E Bernasconi, Dominique L. Braun, H C Bucher, Alexandra Calmy, Matthias Cavassini, Angela Ciuffi, G Dollenmaier, Matthias Egger, Luigia Elzi, Jan Fehr, Jacques Fellay, Hansjakob Furrer, C A Fux, Huldrych F. Günthard, Anna Hachfeld, David Haerry, Barbara Hasse, Hans H. Hirsch, Matthias Hoffmann, Irène Hösli, Michael Huber, David Jackson‐Perry, Christian R. Kahlert, Olivia Keiser, Thomas Klimkait, Roger D. Kouyos, Katharina Kusejko, Niklaus Daniel Labhardt, Karoline Leuzinger, Begoña Martínez de Tejada, Catia Marzolini, Karin J. Metzner, N Müller, Johannes Nemeth, Dunja Nicca, Julia Notter, P Paioni, G Pantaleo, M Perreau, Andri Rauch, Luisa Salazar‐Vizcaya, Patrick Schmid, René Speck, M Stöckle, Philip Tarr, Alexandra Trkola, Gilles Wandeler, Maja Weisser, Sabine Yerly
Abstract
BACKGROUND: Advancements in access to antiretroviral therapy (ART) and human immunodeficiency virus (HIV) care have led to a decline in AIDS-related deaths among people with HIV (PWH) in Switzerland. However, data on the ongoing changes in causes of death among PWH over the past 15 years are scarce. METHODS: We investigated all reported deaths in the Swiss HIV Cohort Study between 2005 and 2022. Causes of death were categorized using the Coding Causes of Death in HIV protocol. The statistical analysis included demographic stratification to identify time trends and logistic regression models to determine associated factors for the underlying cause of death. RESULTS: In total, 1630 deaths were reported, with 23.7% of individuals assigned female sex at birth. These deaths included 147 (9.0%) HIV/AIDS-related deaths, 373 (22.9%) due to non-AIDS, non-hepatic cancers, 166 (10.2%) liver-related deaths, and 158 (9.7%) cardiovascular-related deaths. The median age at death (interquartile range) increased from 45.0 (40.0-53.0) years in 2005-2007 to 61.0 (56.0-69.5) years in 2020-2022. HIV/AIDS- and liver-related deaths decreased, whereas deaths from non-AIDS, non-hepatic cancers increased and cardiovascular-related deaths remained relatively stable. CONCLUSIONS: The proportionally decreasing HIV/AIDS and liver-related deaths showcase the effectiveness of ART, comprehensive HIV patient care, and interventions targeting hepatitis C virus coinfection. Future research should focus on managing cancer and cardiovascular-related conditions as the new leading causes of death among PWH. Comprehensive healthcare strategies focusing on non-AIDS-related comorbid conditions, cancer management, and sustaining liver and cardiovascular health are needed to bridge the ongoing health disparities between PWH and the general population.