Three quarters of the deaths of HIV-positive people in London are due to conditions other than AIDS

More than three quarters of the deaths of HIV-positive people in London
are due to conditions other than AIDS, most of which occur in people
HIV treatment and had undetectable viral load, Valerie Delpech's
Health England declared at 22 ^nd International Conference on AIDS
2018) in Amsterdam this week.

The leading causes of death were liver disease,
cardiovascular disease and AIDS.

All London HIV clinics submitted case reports
deaths among their patients that occurred in 2016. Clinicians were asked to provide
details on comorbidities, antiretroviral therapy, clinical markers,
cause of death and end-of-life care. Two doctors and a pathologist each reviewed

There were 206 deaths in 2016, a number comparable to that of
The previous years. Three-quarters were in men and the median age at death was 56 years.
At the time of death, 81% of people were receiving antiretroviral therapy and 76%
a viral load less than 200 copies / ml. Almost half (44%) of the deaths were considered
to be sudden and 36% to be unexpected.

Among those whose deaths were unexpected, the main causes
of deaths were accidents and suicide (18%), cardiovascular diseases (16%), AIDS
diseases (14%), non-AIDS-related cancers (14%), strokes (10%) and other infections
(10%)

Among the largest group of deaths that had been to some
degree expected, the causes of death were liver disease (29%), the definition of AIDS
diseases (27%), cardiovascular diseases (13%) and non-AIDS
cancers (10%)

These figures are somewhat different from
recent badysis of mortality data, also conducted by Public Health England.
However, this report concerned a much longer and earlier period
(1997-2012) and included more AIDS-related deaths.

In this study, people frequently had
the year before death, including smoking (37%), excessive consumption of alcohol
(19%), drug use without injection (20%) and injection drug use (7%). Co-morbidities
have been frequently reported: depression (39%), high blood pressure (33%),
cholesterol or lipids (27%), viral hepatitis (18%) and diabetes (14%).

In only 48 cases was there a discussion about end-of-life care and
preferences were recorded in the patient's notes. Among those whose death was
61% died at the hospital, with only 17% of deaths in a hospice and 15%
House. Delpech said this shows that improvements in end-of-life care planning are needed.

Deaths could be prevented by expanding HIV testing, so that
People do not have AIDS-related illnesses, she said. In addition, optimal
co-morbidity management, health promotion to reduce behavioral risk
factors and strong psychosocial support could prevent other deaths.