The high mortality rate in HIV positive patients is due to serious illness present before the diagnosis, Danish researchers report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The study showed that one third of the deaths were from diseases that were already present before the diagnosis of VIH.También the report that the mortality rate was significantly higher in HIV patients subject to medication between the Danish population general.
Introduction of antiretroviral therapy in late 1990 led to opportunistic diseases virtually disappear transforming the prognosis of HIV / SIDA.Ahora paradoxically are diseases that are not related to AIDS one of the leading causes of illness and death in HIV patients expected that the number of diseases continue to increase as HIV-positive population ages.
However, the disease severity have acquired prior to diagnosis and its impact on the prognosis of patients with HIV is hardly known.
The Danish researchers conducted a study population of the country for adult patients diagnosed HIV + between 1997 and 2005.
These people remained in the study at least two years and each was paired in line with HIV-negative people of the same sex and age.
Records showed significant details of comorbidity, the researchers then calculated each patient and scored on their controls with the Charlson comorbidity index, designed to predict mortality. Includes serious diseases associated value from 1 to 3 (0, 1, 2, 3 and above) as its impact as a factor in mortality.
A total of 1638 patients were diagnosed with HIV during the study period, and 195 of these people during the years of monitoring.
This provided a mortality rate of 2.09% compared with a rate of only 0.39% among the Danish population in general.
In 22% of patients were present other serious illnesses at the time of HIV diagnosis. This includes 13% of patients who were co-infected with hepatitis C.
preexisting comorbidity significantly increased the risk of death in HIV-positive pacientes.Las who had one or more points on the Charlson Comorbidity Index was significantly higher mortality rates than patients infected with HIV without points in the index (mortality rate = 1.84, 95% CI, 1.32 to 2.57).
The researchers then compared death rates among HIV-positive and HIV-negative controls according to their score of Charlson comorbidity index. In each stratum, HIV-positive individuals had significantly higher mortality.
0 Score: HIV = 1.70 versus 0.27 per 100 person-years.
Score 1: HIV = 4.37 versus 1.36 per 100 person-years.
Score 2: HIV = 8.06 compared to 2.44 per 100 person-years.
score of 3 or more: HIV = 10.15 compared to 5.84 per 100 person-years.
This disproportionate mortality in HIV patients explained by an interaction between HIV and comorbid conditions. Compared with patients without points in the Charlson comorbidity index, the interaction can be attributed to a point 59% mortality of patients with two points to 66% of patients, and 34% of deaths for patients with three or more points.
Overall, researchers estimate that 32% of deaths in HIV patients due to serious illnesses that were present before HIV is diagnosed. On the other hand, 45% of total mortality in HIV patients was due to causes unrelated to HIV.
"We found that influencing morbidity before diagnosis HIV was an independent risk factor for death, "say the authors.
" Almost half the death rate in people diagnosed with HIV with free access in the health centers to HAART [highly active antiretroviral therapy active] is caused by factors unrelated to HIV disease or associated factors, such as toxicity of antiretroviral drugs. On the other hand, comorbidity acquired before HIV diagnosis acts additively with HIV as a risk factor for death. "
add," the considerable burden conferred by acquired diseases before diagnosis of HIV, is more than one in five Patients in this study requires a comprehensive approach to the treatment and cuidado.La participation of a team of specialists is shown clearly needed. "
The researchers suggest that lifestyle and self-care issues may contribute to the high prevalence of preexisting major diseases present in patients at the time of their HIV diagnosis.
" Other studies with biological target and Risk factors for socio-cultural comorbidity needed for improving our understanding of the complex interaction between HIV and HIV disease previously acquired.
Reference - Lohse N et al. Acquired Before HIV diagnosis Comorbidity and Mortality in HIV-infected and uninfected persons: a Danish population-based cohort study. J Acquir Immune Defic Syndr, online edition: doi: 10.1097/QAI.0b013e31821d34ed, 2011 ( click here for an excerpt ) - HIV & AIDS NAM aidsmap news
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