Updated mortality and causes of death in 2020–2021 in people with HIV: a multicenter study in France

Abstract

Objective: The aim of this study was to assess updated mortality and causes of death in people with HIV (PWH) in France. Design and methods: We analyzed all deaths in PWH followed up between January 1, 2020, and December 31, 2021, in 11 hospitals in the Paris region. We described the characteristics and causes of death among deceased PWH, and evaluated the incidence of mortality and associated risk factors using a multivariate logistic regression. Results: Of the 12 942 patients followed in 2020--2021, 202 deaths occurred. Mean annual incidence of death [95% confidence interval (95% CI)] was 7.8 per 1000 PWH (6.3–9.5). Forty-seven patients (23%) died from non-AIDS nonviral hepatitis (NANH)-related malignancies, 38 (19%) from non-AIDS infections (including 21 cases of COVID-19), 20 (10%) from AIDS, 19 (9%) from cardiovascular diseases (CVD), 17 (8.4%) from other causes, six (3%) from liver diseases, and five (2.5%) from suicides/violent deaths. The cause of death was unknown in 50 (24.7%) patients. Risks factors for death were age [adjusted odds ratio (aOR) 1.93; 1.66–2.25 by additional decade), AIDS history (2.23; 1.61–3.09), low CD4+ cell count (1.95; 1.36–2.78 for 200–500 cells/μl and 5.76; 3.65–9.08 for ≤200 versus > 500 cells/μl), and viral load more than 50 copies/ml (2.03; 1.33–3.08), both at last visit. Conclusion: NANH malignancies remained in 2020–2021 the first cause of death. COVID-19 accounted for more than half of the mortality related to non-AIDS infections over the period. Aging, AIDS history, and a poorer viro-immunological control were associated with death.