An analysis of autopsies of people with HIV who died in New York City between 1984 and 1996 has identified various major trends, in particular the decline of opportunistic infections and the rise of non-opportunistic ones, as well as the increasing prevalence of narrowed arteries.
Publishing their findings in the Archives of Pathology and Laboratory Medicine, Amy V. Rapkiewicz, MD, an associate professor in the department of pathology at New York University School of Medicine, and colleagues analyzed 252 autopsies of people with HIV, some of whom had AIDS at the time of their death, conducted at a major New York City hospital.
During the period spanning 1984 to 1995, the hospital conducted an average of 13 autopsies per year on people with HIV. After the introduction of combination antiretroviral treatment in 1996, this figure dropped to 4.5 per year.
The average age of death of the people autopsied was 35 years old in 1984 and 46 years old in 2016. Among all New Yorkers living with HIV during this period, the average age of those who died was 36 years old in 1984 and 54 years old in 2010.
The proportion of the study cohort with an opportunistic infection such as Kaposi sarcoma or pneumocystis pneumonia declined from 79% in 1984 to 1987 to 41% in 2008 to 2011 and to 29% in 2012 to 2016.
Conversely, the proportion of the cohort members who had nonopporuntistic infections, such as hepatitis C virus (HCV), increased from 37% in 1984 to 1987 to 73% in 2008 to 2011 and then declined to 57% in 2012 to 2016.
The proportion of those with AIDS-defining or other cancers did not change over the study period. The prevalence of atherosclerosis (the narrowing or hardening of arteries due to fatty deposits) rose from 21% in 1988 to 1991 to 54% in 2008 to 2011.
The average CD4 count at the time of death increased from 6 in 1992 to 64 in 2016.
According to Rapkiewicz, among New Yorkers with HIV who have died in recent years, the cause of death has been, for the most part, the underlying infection and related disease and not just age-related factors.
To read the study abstract, click here.
To read a press release about the study, click here.