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HIV/AIDS Epidemiology & Mortality

Antiretroviral Therapy Reduces Overall Mortality, but Effects Differ According to HIV Risk Group

Effective combination antiretroviral therapy (ART) has dramatically reduced overall mortality among people with HIV, according to data from the large HIV-CAUSAL Collaboration published in the January 2, 2010 issue of AIDS. Overall, starting treatment reduced the risk of death by about half. Those who started with a low CD4 cell count saw the largest reduction in mortality, but even those who started with more than 500 cells/mm3 had improved survival. However, the HIV-CAUSAL study and another study in Brazil both found that people who became infected with HIV via injection drug use did not benefit as much those infected through sex.

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Math Model Shows Test-and-Treat in South Africa Would Be More Costly than Previously Estimated

A strategy of routinely testing everyone for HIV and immediately treating those found to be infected would cost significantly more than previously estimated by World Health Organization (WHO) researchers, according to a new mathematical model published in the September 18, 2010 issue of The Lancet. In particular, the prior model failed to adequately account for the cost of annual HIV testing and scale-up of health care infrastructure.

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AIDS-related Deaths in France Are More Frequent in Women than in Men since 2000

As reported at the 15th Conference on Retroviruses and Opportunistic Infections (CROI 2008) last week in Boston, French researchers conducted a retrospective sub-study of the Mortalité 2000 and 2005 surveys to determine characteristics at the time of death in women compared to men with HIV/AIDS.

While numerous studies have looked at the changing causes of mortality in people with HIV/AIDS, few have focused on HIV positive women.

All deaths occurring in HIV-infected adults were reported through years 2000 and 2005 in national surveys. A standardized questionnaire collected social, demographic, clinical, biological, and therapeutic characteristics. 


 32% of HIV positive women who died were infected through injection drug use (vs 30% of men) and 53% were infected through heterosexual intercourse (vs 25% of men).

 In women, the age at death was lower than that of men (43 vs 46 years; P < 0.001).

 Socioeconomic "precariousness" was also more common among the HIV positive women compared with men (38% vs 28%; P = 0.006).

 Men also had a higher rate of dyslipidemia (4% vs 10%; P = 0.01).

 The 3 AIDS-related causes of death that were more frequent in 2005 were non-Hodgkin's lymphoma (19% vs 21% in 2000), progressive multifocal leukoencephalopathy (18% vs 3%), and cerebral toxoplasmosis (14% vs 17%).

 Breast cancer was a cause of death in 3% and cervical cancer in 2% of the women.


In conclusion, the investigators noted that, in the context of a global decrease since 2000, "AIDS-related deaths are nowadays more frequent in women than in men."

"Even in a setting of universal access to care, HIV positive women, especially migrants in poor socioeconomic conditions, may not benefit from optimal case management," they added.

Finally, they concluded, "Conversely, the lower proportion of non-AIDS causes of deaths observed in women may be explained by a lower prevalence of traditional risk factors of respiratory or cardiovascular diseases and of violent deaths."

INSERM U593, Bordeaux, France; Ctr Hosp Univ Bordeaux, France; Univ Bordeaux, France; HospPitie-Salpetriere, Paris, France; Univ Pierre and Marie Curie, Paris, France; Ctr Hosp Univ Cochin-Tarnier, Paris, France; Ctr Hosp Nancy, France; Ctr Hosp Univ Nice, France; INSERM U720, Paris, France. 



M Hessamfar-Bonarek, G Chene, D Salmon, and others. (for the Mortalité 2000 & 2005 Study Group). Causes of Death in HIV-infected Women and Their Evolution Since 2000: The Mortalité 2000 and 2005 Surveys, ANRSEN19. 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA. February 3-6, 2008. Abstract 666.