Background Mortality from AIDS has dramatically reduced since the introduction of effective antiretroviral therapy, Nevertheless, HIV infected individuals remain at higher risk of early death. We investigate all causes of deaths among HIV diagnosed adults reported nationally in the HAART era.

Methods Analyses of data from national HIV surveillance linked to the Office National Statistics. Deaths among all adults (≥15) diagnosed between 1997 and 2008 in England and Wales (E&W) were reviewed and grouped by cause of death (COD) and risk information. Death rates were calculated using a census of all persons accessing HIV care in 2008 (SOPHID).

Results The crude mortality rate among HIV-infected individuals (15−59 yrs) fell from 21.8 to 8.2 per 1000 persons living with diagnosed HIV in 2008. A total of 3640 (5.6%) persons diagnosed over the 12-year period were reported to have died [3544 had a cause of death]. The overall median age at death was 41 yearss [IQR: 35−50 years]. AIDS related mortality accounted for 56% of all deaths: 51% among MSM, 61% among heterosexuals and 34% among IDUs. AIDS-related respiratory infection (including PCP) was the most common COD in MSM and heterosexuals whereas external causes were the most common COD among IDUs. Non AIDS mortality increased sixfold since 1997 (36−226), with particular increases in cardio/cerebrovascular disease, non-AIDS defining malignancies and external causes. Infectious diseases (mostly respiratory) was the most common underlying cause of non AIDS deaths for MSM and heterosexuals aged 15−59: (38% and 36% respectively) and also high among IDUs (35%). External causes (mostly due to overdose and suicide) was the most common COD among IDUs (36%) and high among MSM (19%). Cardio/cerebrovascular disease and non AIDS malignancies accounted for 16% and 11% of non-AIDS deaths (15−59 years) respectively. Three quarters (76%) of all AIDS deaths and 47% of non AIDS deaths occurred within a year of diagnosis.

Conclusion Overall mortality rates in HIV positive persons have substantially declined in the HAART era but remain high compared to the general population. Clinical AIDS associated with late presentation continues to account for the majority of deaths. Our analyses also reveal that a disproportionate number of deaths are due to infectious diseases, overdose and suicide occur in this population, many of which may be preventable. Surveillance of non-AIDS causes of death is critical in the HAART era.