Analysis of the causes of death in HIV-infected individuals in 2008-2010 according to the data of the clinical infectious diseases hospital named after S.P. Botkin, St. Petersburg

Aim. To analyse the causes of death of individuals infected with the human immunodeficiency virus (HIV)/patients with acquired immunodeficiency syndrome (AIDS) in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010 taking into account the timing of disease, comorbidities, and clinical and laboratory data. Methods. The study included 439 HIV-infected individuals, who died in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010. Two groups of patients were identified: deaths from HIV/AIDS (n=306) and from other diseases (n=133, HIV infection was considered to be a concomitant disease). In both groups, analyzed were the short-term mortality rates, the presence of drugs and/or alcohol dependency, and the main causes of death (according to autopsy results). Results. In the group of patients who died of HIV-infection/AIDS and who did not receive antiretroviral therapy, generalized tuberculosis was diagnosed most often (65.7% of cases). Other rare diseases were pneumocystis pneumonia, cryptococcosis, cerebral toxoplasmosis, generalized fungal infection, cerebral lymphoma, and cytomegalovirus infection. The most frequent causes of death in the group of patients whose HIV-infection was considered to be a concomitant diseases were chronic viral hepatitis in the cirrhotic stage (42.9%) and septic thromboendocarditis, which were mainly diagnosed in social maladjusted patients: patients with alcoholism or intravenous drugs users. During evaluation of the short-term mortality rates it was established that 21 to 29% of patients in different years died on the 1st-3rd day after admission, which was related to extremely severe conditions of the patients. In Russia, including St. Petersburg, an annual increase in the number of new cases of HIV infection and increased mortality are registered, which indicates the severity of the epidemic and makes it possible to predict the increase in the number of patients requiring hospital treatment. Conclusion. The main causes of death among HIV-infected individuals in 2008-2010 were generalized tuberculosis and chronic viral hepatitis in the stage of cirrhosis; the high index of short-term mortality among HIV-infected patients suggests the need for measures for early detection of HIV-positive individuals and their medical examination, as well as an increase in the number of beds in order to provide specialized care to HIV-infected individuals in St. Petersburg.

HIV infection, chronic viral hepatitis, drug users, short-term mortality, antiretroviral therapy