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By the end of 2000, over 450,000 deaths among
persons with AIDS in the United States and territories
had been reported to the Centers for Disease Control
and Prevention. This report describes deaths among
persons with AIDS, by year of death, age group, geographic
area, exposure category, and race/ethnicity.
Deaths among persons with AIDS can be attributable
to any cause of death, not necessarily HIV-related disease.
This report also includes death certificate data
collected by the National Center for Health Statistics
on the leading causes of death, including HIV disease
in the general population.
The number of deaths in persons with AIDS increased
each year from the beginning of the epidemic
until 1995, reflecting the increase in incidence through
the 1980s and early 1990s. Declines in the number of
deaths in 1996 and 1997 were considerably greater
than expected if based only on the decrease in incidence.
The introduction of highly active antiretroviral
therapy (HAART) in 1996 had a dramatic effect on the
survival time of persons with HIV infection and AIDS
(figures 1 and 2), resulting in large increases in the
number of persons living with HIV and AIDS. Decreases
over the past several years in the number of
deaths among persons with HIV and AIDS are evident
in all geographic and demographic groups in the United
States.
The decrease in the number of deaths among persons
with AIDS was first evident in 1994 among
whites and Asian/Pacific Islanders and the following
year among all other racial/ethnic groups (figures 4
and 5), and both men and women (figure 6). Declines
in deaths somewhat reflect differential declines in
AIDS incidence among persons in the different exposure
categories. Stratified by category of exposure to
HIV (figure 8), the number of reported deaths first began
to decrease in 1990 among persons exposed
through blood transfusions, blood components, or tissue,
followed by decreases in 1994 among men exposed
through receipt of clotting factor. In 1995 and
1996 decreases in deaths were seen among persons
with AIDS exposed through heterosexual contact. Deaths in states in the West and U.S. territories began
to decrease one year before those in the other regions
(figure 9).
Data from the National Vital Statistics System show
that from 1992 through 1995, HIV infection was the
eighth leading cause of death among all persons in
the United States. In 2000, HIV infection was the 18th
leading cause of death. In selected demographic
groups, HIV remains a high ranking cause of death.
Among persons 25-44 years old, HIV was the most
common cause of death in 1994 and 1995. In 2000, it
was the 5th
leading cause of death, after unintentional
injury, cancer, heart disease, and suicide in this age
group (figure 10).
Despite overall declines in mortality among persons
with HIV/AIDS, mortality rates vary by region and
race (table 3) and age group and race (table 6). Addressing
disparities in care, preventing secondary
transmission, and meeting the social and medical
needs of persons living with HIV or AIDS remain public
health challenges.
Additional reading:
Fleming PL, Ward JW, Karon JM, Hanson DL, De Cock KM. Declines in AIDS incidence and deaths in
the USA: a signal change in the epidemic.
AIDS.
1998;112(supp A):S55-S61.
Karon JM, Fleming PL, Steketee RW, De Cock KM.
HIV in the United States at the turn of the century: an
epidemic in transition.
Am J Public Health.
2001;91:1060-1068.
Lee LM, Karon JM, Selik R, Neal JJ, Fleming PL.
Survival after AIDS diagnosis in adolescents and
adults during the treatment era, United States, 1984-
1997.
JAMA.
2001;285:1308-15.
Public use slides on mortality among persons with
HIV/AIDS are available at: www.cdc.gov/hiv/graphics/mortalit.htm
Information about cause-of-death data from death
certificates is available at:
www.cdc.gov/nchs/about/major/dvs/mortdata.htm |
