ABSTRACT
OBJECTIVES: Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review. METHODS: Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017. Using expert review as the gold standard, we measured sensitivity, specificity, and agreement. RESULTS: The NDI had a sensitivity of 53.9% and a specificity of 66.7% for HIV deaths. The NDI had a moderate sensitivity for non-AIDS-related infectious diseases and non-AIDS-related cancers (70.6% and 75.0%, respectively) and high specificity for these causes (100.0% and 94.7%, respectively). The NDI had low sensitivity and high specificity for substance abuse (27.3% and 100.0%, respectively), heart disease (58.3% and 86.8%, respectively), hepatitis B/C (33.3% and 97.7%, respectively), and mental illness (50.0% and 97.8%, respectively). The measure of agreement between expert review and the NDI was lowest for HIV (κ = 0.20); moderate for heart disease (κ = 0.45) and hepatitis B/C (κ = 0.40); high for non-AIDS-related infectious diseases (κ = 0.76) and non-AIDS-related cancers (κ = 0.72); and low for all other causes of death (κ < 0.35). CONCLUSIONS: Our findings support education and training of health care providers to improve the accuracy of cause-of-death information on death certificates.
Subject(s)
Cause of Death/trends , Data Collection/standards , Death Certificates , HIV Infections/epidemiology , Adult , Aged , Comorbidity , Female , HIV Infections/mortality , HIV Infections/transmission , Humans , Male , Middle Aged , San Francisco/epidemiology , Sensitivity and SpecificityABSTRACT
BACKGROUND: Neutropenia is well described in individuals infected with human immunodeficiency virus (HIV) and occurs in approximately 10% to 50% of cases. Neither the effect of highly active antiretroviral therapy (HAART) on neutrophil counts nor the significance of neutropenia in terms of survival has previously been evaluated. METHODS: The prevalence of neutropenia among 1729 HIV-infected women, followed up as part of the Women's Interagency HIV Study, was evaluated. The CD4 lymphocyte counts, HIV-1 RNA levels, and complete blood cell counts, including absolute neutrophil counts, were obtained at 6-month intervals. RESULTS: Neutropenia was common among HIV-infected women; at baseline, 44% had neutrophil counts less than 2000/microL, whereas 7% had counts less than 1000/microL. During 7.5 years of follow-up, neutrophil counts less than 2000/microL occurred on at least 1 occasion in 79%, whereas absolute neutrophil counts less than 1000/microL were documented in 31%. Worsening HIV disease parameters, such as lower CD4 cell counts (P<.001) and higher HIV-1 RNA levels (P<.001), were associated with development of neutropenia. Resolution of neutropenia was associated with higher CD4 cell counts (P<.001) and use of HAART (P=.007). We found that HAART, without zidovudine, was associated with protection against development of neutropenia. On multivariate analysis, neutropenia was not found to be associated with decreased survival among HIV-infected women. CONCLUSIONS: Worsening HIV disease parameters are associated with neutropenia in HIV-infected women. Treatment with HAART, without zidovudine in the regimen, protects against development of neutropenia, whereas HAART use and higher CD4 cell counts are associated with resolution of neutropenia. Neutropenia is not associated with decreased survival in HIV-infected women.
Subject(s)
HIV Infections/complications , Neutropenia/epidemiology , Neutropenia/etiology , Adolescent , Adult , Aged , Antiretroviral Therapy, Highly Active , Female , Follow-Up Studies , HIV Infections/drug therapy , Humans , Middle Aged , Neutropenia/drug therapy , Prevalence , Risk Factors , Severity of Illness IndexSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Mycobacterium Infections/diagnosis , Spinal Diseases/diagnosis , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , Adult , Antitubercular Agents/administration & dosage , Gait Disorders, Neurologic/etiology , HIV Infections/complications , HIV Infections/diagnosis , Herpes Zoster/complications , Herpes Zoster/diagnosis , Humans , Magnetic Resonance Imaging , Male , Mycobacterium Infections/complications , Mycobacterium Infections/drug therapy , Recurrence , Spinal Diseases/complications , Thoracic Vertebrae/pathology , Vasculitis/diagnosis , Vasculitis/drug therapy , Vasculitis/virology , Viral LoadABSTRACT
Osteonecrosis, osteopenia and osteoporosis, hypertension, and mitochondrial toxicity are among the medical conditions observed in patients with HIV disease. In some cases, these disorders have been associated with antiretroviral therapy or particular antiretroviral agents. In other cases, their etiology remains unclear. Meg D. Newman, MD, discussed data from studies of these conditions and current management approaches at the Clinical Pathway of the Ryan White CARE Act 2002 All Grantee Conference held in Washington, DC, in August 2002.
