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Trends in Infectious Diseases and Cancers among Persons Dying of HIV Infection in the United States from 1987 to 1992

Richard M. Selik, MD; Susan Y. Chu, PhD; and John W. Ward, MD
[+] Article and Author Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia. Acknowledgment: The authors thank Debra L. Hanson, MS, for advice on statistical methods. Requests for Reprints: Richard M. Selik, MD, Centers for Disease Control and Prevention, Mail-Stop E47, 1600 Clifton Road, Atlanta, GA 30333. Current Author Addresses: Drs. Selik, Chu, and Ward: Centers for Disease Control and Prevention, Mail-Stop E47, 1600 Clifton Road, Atlanta, GA 30333.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(12):933-936. doi:10.7326/0003-4819-123-12-199512150-00006
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Objective: To determine trends in the relative frequency of infectious diseases and cancers among U.S. residents dying of human immunodeficiency virus (HIV) infection.

Data Source: National multiple-cause mortality data for 1987 to 1992 compiled from death certificates.

Subjects: Deaths reported with HIV infection as the underlying cause and with nonunderlying causes that could be secondary to HIV infection.

Data Analysis: Trends in the annual percentage of deaths associated with each infectious disease or cancer that accounted for at least 1.0% of all HIV-related deaths.

Results: From 1987 to 1992, the percentage of HIV-related deaths associated with the following diseases decreased: pneumocystosis, from 32.5% to 13.8%; cryptococcosis, from 7.7% to 5.0%; and candidiasis, from 2.3% to 1.7%. The percentage of deaths associated with the following diseases increased: nontuberculous mycobacteriosis, from 6.7% to 12.2%; cytomegalovirus disease, from 5.2% to 9.9%; bacterial septicemia, from 9.0% to 11.5%; non-Hodgkin lymphoma, from 3.9% to 5.7%; tuberculosis, from 2.9% to 4.1%; progressive multifocal leukoencephalopathy, from 0.8% to 1.9%; bacterial pneumonia, from 1.2% to 2.1%; and cryptosporidiosis or isosporiasis, from 0.7% to 1.2%. The percentages of deaths associated with toxoplasmosis, Kaposi sarcoma, and pneumonia caused by unspecified organisms had no significant linear trends (ranges from 4.9% to 5.5%, 10.4% to 12.1%, and 17.6% to 18.6%, respectively).

Conclusions: The percentage of HIV-related deaths associated with pneumocystosis has decreased dramatically, probably because of chemoprophylaxis and improved treatment. Pneumonia caused by unspecified organisms has now become the leading secondary cause of death among persons dying of HIV infection. Decreases in the percentages of HIV-related deaths associated with cryptococcosis and candidiasis may reflect the use of new antifungal agents such as fluconazole.

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Figure 1.
Trends in the prevalence of infectious diseases and cancers reported among persons dying of human immunodeficiency virus infection in the United States from 1987 to 1992.
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