In high-income countries, the use of highly active antiretroviral therapy (HAART) has greatly decreased deaths and illness due to AIDS. However, the benefits of HAART have not been as dramatic in some HIV positive women as they have been in HIV positive men. The reasons for this difference are not clear, but perhaps they involve issues around access to care and treatment.
Researchers in the United States conducted a study to examine the causes of death in HIV positive women. To do this, they examined information in death certificates. This information was collected from a large group of women, most of whom were HIV positive and some who were at high risk of becoming positive. The study took place between 1994 and 2000, and during that time the researchers found that 18% of the women died. A large minority of these deaths was from causes apparently unrelated to AIDS. The study authors concluded that in order to decrease death rates further, HIV positive women need to have care that increases its focus on conditions such as "hepatitis C, depression, drug and tobacco use."
Researchers recruited 2,059 HIV positive women between October 1994 and November 1995 for this study. Data up to April 2000 was collected and analysed. The profile of the women who enrolled in the study was as follows:
There were also 569 women who were HIV negative when they entered the study but our report focuses mostly on the HIV positive women.
The women did not use combination therapy with a protease inhibitor or non-nuke until the early part of 1996. This point is noteworthy because deaths due to AIDS began to decline significantly in that year. Among the women, AIDS-related deaths declined by an average of 31% each year of the study. In contrast, deaths unrelated to AIDS remained stable throughout the study.
By the end of the study, the number of deaths in the following groups were:
The researchers calculated that the rate of death was seven-fold greater among HIV positive women when compared to those without HIV.
Among HIV positive women, AIDS-related complications were responsible for 71% of deaths. The common causes of death were as follows:
A large minority of deaths (91 women) was due to causes other than AIDS, including the following:
Non-AIDS-defining cancers that occurred were as follows:
On average, women who died from complications due to AIDS usually had a higher average viral load (220,000 copies) than women who survived (14,000 copies) or even women who died from causes unrelated to AIDS (55,000 copies). On average, HIV positive women who died from causes other than AIDS had the following factors in common:
All in all, the researchers found that women who died from causes other than AIDS were "extremely vulnerable." The researchers noted that 75% of these women experienced depression, and more than 80% used injection drugs.
If deaths due to factors other than AIDS are to be reduced in this population, HIV positive women need to be assessed for depressive illness and drug use, and they also need to have these conditions effectively managed. As well, screening for and treatment of hepatitis C virus infection should be incorporated into their health care. Because other studies have also found that HIV positive women experience a high level of domestic violence, programs that address this issue are needed as well.
REFERENCE
Cohen MH, French AL, Benning L, et al. Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy. American Journal of Medicine 2002 Aug 1;113(2):91-8.
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