Death rate from HIV dropped to half in rich countries during past decade

A new study has revealed that the overall death rate has been cut to half among the people with AIDS living in the world’s rich countries and receiving care and antiretroviral therapy (ART), compared with a decade ago. The study involved nearly 50, 000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe, USA, and Australia found that overall death rates have almost halved since 1999, while deaths due to AIDS-related causes and cardiovascular disease have declined by around 65 percent and liver-related deaths by more than 50 percent.

Although deaths from most causes declined over the study period, there was no reduction in death rates from non-AIDS cancers which remained stable over time (1.6 deaths per 1000 years 1999-2000 to 2.1 in 2009-2011). Non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV, accounting for 23 percent of all deaths. Of the 3909 deaths that occurred over the study period, around 29 percent of individuals died from an AIDS-related cause, which remains the most common cause of death. Cancers (15percent; mainly lung cancer) were the most frequent causes of non-AIDS deaths, followed by liver disease (13 percent; mainly due to hepatitis), and cardiovascular disease (11percent). 

Mortality decreased from about 17.5 deaths per 1000 person-years in 1999-2000 to 9.1 deaths per 1000 years in 2009-2011-a drop of around 50 percent. Similar decreases in deaths related to AIDS (5.9 deaths per 1000 person-years to 2.0), liver disease (2.7 to 0.9), and cardiovascular disease (1.8 to 0.9) were also seen. The proportion of all deaths due to AIDS (34 percent to 23 percent) and liver disease (16 percent to 10 percent) declined over the decade, while the proportion of deaths due to cardiovascular disease remained constant at 10 percent.

Dr Colette Smith, University College London in the UK, said that these recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count and provide further evidence of the substantial net benefits of ART. He further explained that despite these positive results, AIDS-related disease remains the leading cause of death in this population and continued efforts to ensure good ART adherence and to diagnose more individuals at an earlier stage before the development of severe immunodeficiency are important to ensure that the low death rate from AIDS is sustained and potentially decreased even further. 

The study is published in The Lancet.

How is the disease diagnosed?

The only way to diagnose HIV is to take a test which looks for signs of the virus in the blood. Presence of the virus in the blood is termed as HIV positive (HIV+). If no signs of the virus are found in the blood, the result is considered negative. It is diagnosed on the basis of positive results from two different HIV tests.

The plasma HIV RNA test (a viral load test) is recommended when recent infection is suspected. The test detects the virus in the blood within 9 days of infection; before the body develops detectable antibodies to it.

Antibody tests: The antibody tests check for HIV antibodies that the body produces in response to the infection. In most people, antibodies to the virus are not detectable during awindow period of 3 to 12 weeks after infection. Hence, a HIV antibody test is not useful during this period. Retesting should be done after three months to confirm the test results. Some of the antibody tests are as follows:

• Rapid HIV antibody test, the most common HIV test, is done using blood, urine or saliva and can produce results within an hour.
• Enzyme-linked immunosorbent assay (ELISA) is an antibody test that is usually the first one used to detect HIV infection. If the result is positive, the test is usually repeated to confirm the diagnosis.
• Western blot test is one of the oldest but most accurate confirmatory antibody tests. It is done to confirm the results of two positive ELISA tests

Polymerase chain reaction (PCR, a viral load test) test finds either the RNA or the DNA of the HIV in white blood cells even if other tests are negative for the virus. The PCR test is very useful to find a very recent infection, screen blood for HIV before donation and in babies born to mothers infected with the virus.

Protein p24, the antigen on HIV that produces an antibody response in the body is produced in excess early in the infection. Antigen p24 tests detect these proteins in the blood. This test is usually not used for general HIV diagnostic purposes.

HIV-infected people may not have any symptoms of disease for eight to ten years or longer (asymptomatic period). Their CD4 (T-cell) count should be watched closely during this time. If they have a CD4 count below 200 and/or if AIDS-related conditions appear, then they are considered to have AIDS.