Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
HIV Med. 2013 Apr;14(4):195-207. doi: 10.1111/j.1468-1293.2012.01051.x. Epub 2012 Sep 24.
Mortality among HIV-infected persons is decreasing, and causes of death are changing. Classification of deaths is hampered because of low autopsy rates, frequent deaths outside of hospitals, and shortcomings of International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding.
We studied mortality among Swiss HIV Cohort Study (SHCS) participants (1988-2010) and causes of death using the Coding Causes of Death in HIV (CoDe) protocol (2005-2009). Furthermore, we linked the SHCS data to the Swiss National Cohort (SNC) cause of death registry.
AIDS-related mortality peaked in 1992 [11.0/100 person-years (PY)] and decreased to 0.144/100 PY (2006); non-AIDS-related mortality ranged between 1.74 (1993) and 0.776/100 PY (2006); mortality of unknown cause ranged between 2.33 and 0.206/100 PY. From 2005 to 2009, 459 of 9053 participants (5.1%) died. Underlying causes of deaths were: non-AIDS malignancies [total, 85 (19%) of 446 deceased persons with known hepatitis C virus (HCV) status; HCV-negative persons, 59 (24%); HCV-coinfected persons, 26 (13%)]; AIDS [73 (16%); 50 (21%); 23 (11%)]; liver failure [67 (15%); 12 (5%); 55 (27%)]; non-AIDS infections [42 (9%); 13 (5%); 29 (14%)]; substance use [31 (7%); 9 (4%); 22 (11%)]; suicide [28 (6%); 17 (7%), 11 (6%)]; myocardial infarction [28 (6%); 24 (10%), 4 (2%)]. Characteristics of deceased persons differed in 2005 vs. 2009: median age (45 vs. 49 years, respectively); median CD4 count (257 vs. 321 cells/μL, respectively); the percentage of individuals who were antiretroviral therapy-naïve (13 vs. 5%, respectively); the percentage of deaths that were AIDS-related (23 vs. 9%, respectively); and the percentage of deaths from non-AIDS-related malignancies (13 vs. 24%, respectively). Concordance in the classification of deaths was 72% between CoDe and ICD-10 coding in the SHCS; and 60% between the SHCS and the SNC registry.
Mortality in HIV-positive persons decreased to 1.33/100 PY in 2010. Hepatitis B or C virus coinfections increased the risk of death. Between 2005 and 2009, 84% of deaths were non-AIDS-related. Causes of deaths varied according to data source and coding system.
感染艾滋病毒的人的死亡率正在下降，死因也在发生变化。由于尸检率低、经常在医院外死亡以及国际疾病分类与相关健康问题（ICD-10）编码的缺陷，导致对死亡原因的分类受到阻碍。
我们使用编码艾滋病毒死亡原因（CoDe）方案（2005-2009 年）研究了瑞士艾滋病毒队列研究（SHCS）参与者（1988-2010 年）的死亡率和死亡原因。此外，我们将 SHCS 数据与瑞士国家队列（SNC）死因登记处进行了关联。
艾滋病相关死亡率在 1992 年达到峰值[每 100 人年（PY）11.0]，并下降至 0.144/100 PY（2006 年）；非艾滋病相关死亡率在 1.74（1993 年）和 0.776/100 PY（2006 年）之间；未知原因死亡率在 2.33 和 0.206/100 PY 之间。2005 年至 2009 年，9053 名参与者中有 459 人（5.1%）死亡。死亡的根本原因是：非艾滋病恶性肿瘤[总数，446 名已知丙型肝炎病毒（HCV）状态的死者中有 85 人（19%）；HCV 阴性者 59 人（24%）；HCV 合并感染者 26 人（13%）]；艾滋病[73 人（16%）；50 人（21%）；23 人（11%）]；肝功能衰竭[67 人（15%）；12 人（5%）；55 人（27%）]；非艾滋病感染[42 人（9%）；13 人（5%）；29 人（14%）]；药物滥用[31 人（7%）；9 人（4%）；22 人（11%）]；自杀[28 人（6%）；17 人（7%），11 人（6%）]；心肌梗死[28 人（6%）；24 人（10%），4 人（2%）]。2005 年与 2009 年死者的特征有所不同：中位年龄（分别为 45 岁和 49 岁）；中位 CD4 计数（分别为 257 和 321 个细胞/μL）；未接受抗逆转录病毒治疗的个体比例（分别为 13%和 5%）；与艾滋病相关的死亡比例（分别为 23%和 9%）；与非艾滋病相关的恶性肿瘤死亡比例（分别为 13%和 24%）。CoDe 和 SHCS 中的 ICD-10 编码在死亡分类方面的一致性为 72%；SHCS 与 SNC 登记处的一致性为 60%。
2010 年，艾滋病毒阳性者的死亡率降至 1.33/100 PY。乙型肝炎或丙型肝炎病毒合并感染增加了死亡风险。2005 年至 2009 年，84%的死亡是非艾滋病相关的。死因因数据来源和编码系统而异。
