Causes of death in people living with HIV from a North London cohort between 2006 and 2023: A descriptive analysis.

Background: The provision of highly active anti-retroviral therapy has improved outcomes for people with HIV, worldwide. There are few data on trends and changes in the cause of death among people with HIV in the United Kingdom since its advent.

Methods: We retrospectively reviewed deaths in people attending HIV services at Royal Free Hospital London between 2006 and 2023. Cause of death was categorized using the CoDe protocol. Analysis included description of demographics over time, HIV-specific metrics (late diagnoses, AIDS-defining illnesses) and aspects related to HIV treatment and trends in non-AIDS-related causes of death.

Results: Of 529 deaths, 79.8% were male. Cause of death was non-AIDS-defining malignancy 21.4%, non-AIDS-defining infection 12.1%, AIDS-defining infection 11.2%, AIDS-defining malignancy 7.8%, self-harm 9.3%, cardiovascular 8.3%, liver 2.8%, respiratory 2.6%, other 7.2% and unknown 17.4%. Comparing 2006-2011 and 2018-2023, the proportion of those dying from AIDS-defining infection and malignancy fell from 13.8% to 7.1%, and from 13.8% to 3.1%, respectively; median age at death increased from 44.9 years (interquartile range [IQR] 39.7-52.4) to 58.0 (IQR 52.0-67.7): p < 0.001 and median interval between HIV diagnosis and death increased from 8.5 years (IQR 2.9-14.0) to 19.1 (IQR 11.8-26.1): p < 0.001.

Conclusions: Between 2006 and 2023, there was a significant increase in median age at death and in the interval between HIV diagnosis and death. The proportion of deaths associated with AIDS-defining infection and malignancy fell, while non-AIDS-defining infection, malignancy and deaths from self-harm increased. These data suggest that focusing on earlier diagnosis, holistic clinical management and support for mitigating modifiable lifestyle risk factors including cancer screening and mental health services could result in improved outcomes and reduce preventable deaths.