Kaiser Daily HIV/AIDS Report Highlights Recently Released Journal Articles
The following highlights recently released journal articles on HIV/AIDS.
- "Causes of Death Among Persons With AIDS in the Era of Highly Active Antiretroviral Therapy: New York City," Annals of Internal Medicine: Judith Sackoff and colleagues at the New York City Department of Health and Mental Hygiene examined the death certificates of 68,669 HIV-positive people ages 13 and older who died from 1999 through 2004 and whose deaths were reported to the New York City HIV/AIDS Reporting System and Vital Statistics Registry (Sackoff et al., Annals of Internal Medicine, 9/19). The study finds that 26.3% of HIV-positive people in the city who died from 1999 through 2004 did not die of AIDS-related illnesses. This represents a 32% increase since 1999, during which slightly less than 20% of HIV-positive people died of causes other than AIDS-related illnesses, Reuters reports. According to the study, among the deaths attributed to non-AIDS-related illness, 31% percent of HIV-positive people died because of substance abuse; nearly 24% died of cardiovascular disease; and 20% died of cancer unrelated to HIV/AIDS (Reuters, 9/18). The researchers concluded, "Reducing deaths from these causes requires a shift in the health care model for persons with AIDS from a primary focus on managing HIV infection to providing care that addresses all aspects of physical and mental health" (Annals of Internal Medicine, 9/19).
- "Discordance Between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men," Annals of Internal Medicine: Preeti Pathela of the New York City Department of Health and Mental Hygiene and colleagues analyzed the findings of a 2003 health department survey of 4,193 men ages 18 and older residing in New York City, the Philadelphia Inquirer reports (Fallik, Philadelphia Inquirer, 9/19). Participants -- 4% of whom said they were homosexual; 91% of whom said they were heterosexual; and the rest of whom said they were bisexual, "unsure" or did not answer -- were asked about their sexual behavior and their sexual orientation, Reuters Health reports. The study finds that about 10% of the men who said they were heterosexual had slept with a man but not a woman in the previous year, and that such men were less likely to have had an HIV test than men who said they were homosexual (Reuters Health, 9/18). The study also finds that 22% of men who have sex with men but who described themselves as heterosexual used condoms, compared with 55% of men who considered themselves gay. The majority of self-described heterosexual MSM were minorities or were born outside the U.S., researchers said (Philadelphia Inquirer, 9/19). The study also finds that self-described heterosexuals in general had fewer sexual partners compared with men who considered themselves homosexual. According to the researchers, the findings imply that physicians should not depend on a man's self-described sexual orientation when assessing his risk for contracting HIV or other sexually transmitted infections (Reuters Health, 9/18).
- "Emergence of Drug Resistance Is Associated With an Increased Risk of Death Among Patients First Starting HAART," PLoS Medicine: Robert Hogg of the British Columbia Centre for Excellence in HIV/AIDS and colleagues analyzed the health records of 1,138 HIV-positive people who began highly active antiretroviral therapy from Aug. 1, 1996, through Sept. 30, 1999, to determine the impact of the emergence of drug-resistant mutations on survival rates. The study finds that during the follow-up period -- which was an average of five years -- an 18.2% mortality rate, or 207 deaths, occurred. In addition, 26.5% of participants during follow up were identified as being resistant to HAART, the study finds. According to the study, resistance to HAART was associated with a 1.75 times higher mortality rate overall, and when each class of antiretroviral was considered separately, resistance to non-nucleoside reverse transcriptase inhibitors were associated with a 3.02 times higher mortality rate. The researchers concluded that the "emergence of resistance to non-nucleoside reverse transcriptase inhibitors was associated with a greater risk of subsequent death than was emergence of protease inhibitor resistance. Future research is needed to identify the particular subpopulations of men and women at greatest risk and to elucidate the impact of resistance over a longer follow-up period" (Hogg et al., PLoS Medicine, September 2006).