Structure of fatal outcomes in patients with HIV infection treated in the aids center hospital

The aim. To study and analyze the main causes of death of patients with HIV infection who died in the hospital of the St. Petersburg AIDS and Infectious Diseases Center, taking into account the stage of the disease and the duration of the disease, opportunistic and other comorbid pathology, and the use of antiretroviral therapy (ART).

Materials and methods. For the period from 2016 to 2023, an analysis of hospitalizations of patients in the AIDS Center hospital and an analysis of fatal outcomes was conducted based on hospital records, statistical reports, pathological protocols, and protocols of commissions for the study of fatal outcomes. A retrospective analysis of 397 medical histories of deceased patients was conducted.

Results and discussion. During the analyzed period, 397 patients died, of whom 74% were treated in the intensive care unit, 4% were died within the first 24 hours of stay; 17% of patients were sent to the palliative care unit; 86% died in the progressive stages of HIV infection, in 73% opportunistic diseases (OD) played a major role in fatal outcomes, concomitant pathology was recorded in 98%. Among patients who died in stage 4V (Clinical classification of HIV infection, Russia, 2006) due to the development of opportunistic diseases, the average CD4 lymphocyte count was 75.9 cells/μl, the amount of HIV RNA in the blood was 6811 33.18 cop/ml. More than a third of deceased patients had several competing diseases that served as the cause of death. In the structure of causes leading to death, the leading role was played by central nervous system (CNS) lesions of various origins (46.8%); pneumonia — 32.5%, including pneumocystis pneumonia — 11.3%, mycobacteriosis — 7%, oncohematological diseases — 19.6%, chronic viral hepatitis in the stage of decompensated liver cirrhosis — 22.7%.

Conclusion. The development of adverse outcomes in HIV-infected patients is influenced by a number of factors: progression of HIV infection (stage 4V, low immune status, high viral load), development of severe generalized opportunistic diseases, especially several competing forms, concomitant pathology, non-adherence to dispensary observation and treatment, absence/late onset, irregularity, interruption of antiretroviral therapy and drugs for the prevention of opportunistic infections, unfavorable social status.

1. Fact sheet — latest statistics on the status of the AIDS epidemic. UNAIDS. 2023. Доступно на: https://www.unaids.org/en/resources/fact-sheet.

2. Human Immunodeficiency Virus — Medicine: A Guide for Physicians / еd. by N. A. Belyakov, A. G. Rakhmanova. St. Petersburg: Publishing House Baltic Medical Educational Center, 2010. 752 p. (In Russ.).

3. Luo B., Sun J., Cai R., Shen Yi., Liu L., Wang J. et al. Spectrum of Opportunistic Infections and Risk Factors for In-Hospital Mortality of Admitted AIDS Patients in Shanghai // Medicine (Baltimore). 2016. May; Vol. 95, No. 21. e3802.

4. Mor Z., Sheffer R., Chemtob D. Causes of death and mortality trends of all individuals reported with HIV/AIDS in Israel, 1985–2010 // J. Public. Health (Oxf). 2017 Jun 17. Р. 1–9. doi: 10.1093/pubmed/fdx039.

5. Simmons R.D., Simmons R.D., Ciancio B.C., Kall M.M., Rice B.D., Delpech V.C. Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer // HIV Medicine. 2013. Vol. 14. Р. 596–604.

6. Kalacheva G.A., Rubina Yu.L., Rudakov N.V. HIVrelated mortality statistics in Siberian federal region in 2005–2016. HIV Infection and Immunosuppression, 2017, Vol. 9, No. 4, рр. 79–85 (In Russ.). doi: http://dx.doi.org/10.22328/2077-9828-2017-9-4-79-85.

7. Leonova O.N., Stepanova E.V., Belyakov N.A. Severe and comorbid conditions in patients with HIV infection: analysis of adverse outcomes. HIV Infection and Immunosuppressive Disorders, 2017, Vol. 9, No. 1, pp. 55–64 (In Russ.). doi: http://dx.doi.org/10.22328/2077-9828-2017-9-1-55-64

8. Matsiyeuskaya N.V., Kashevnik T.I., Kopytski A.V., Skhazka A.E. Age and gender aspects of HIV-infected patients mortality. HIV Infection and Immunosuppressive Disorders, 2020, Vol. 12, No. 4, рр. 51–59 (In Russ.). https://doi.org/10.22328/2077-9828-2020-12-4-51-59.

9. Azovtseva O.V., Trofimova T.S., Arkhipov G.S., Ogurtsova S.V., Panteleev A.M., Belyakov N.A. Letal outcomes in patients with HIV- infection, parallels with adequacy of diagnostics, dispenser and treatment. HIV Infection and Immunosuppressive Disorders, 2018, Vol. 10, No. 3, pp. 90–101 (In Russ.). https://doi.org/10.22328/2077-9828-2018-10-3-90-101.

10. Barash N.A., Vashukova M.A., Buzunova S.A. Study of AIDS-associated mortality in an infectious diseases hospital of a large metropolis in 2020–2022 // Journal of Infectology, 2024, Vol. 16, No. 2, рр. 217–218 (In Russ.).

11. Koshevaya E.G., Zinserling V.A. Secondary diseases in tanatogenesis in HIV infection. HIV Infection and Immunosuppressive Disorders, 2019, Vol. 11, No. 1, рр. 46–55 (In Russ.). https://doi.org/10.22328/2077-9828-2019-11-1-46-55

12. Kravchenko A.V., Ladnaya N.N., Kozyrina N.V., Pokrovsky V.V., Sokolova E.V., Dementieva L.A. Causes of death among HIV-infected individuals in the Russian Federation in 2008–2018 // Epidemiology and infectious diseases, 2020, No. 3, рр. 63–69. (In Russ.). DOI: https://dx.doi.org/10.18565/epidem.2020.10.3.63-9.

13. Stepanova E.V., Shelomov A.S., Bazuk E.M., Kabanova V.I., Kizhlo S.N. Characteristics of fatal outcomes in patients with HIV infection. Journal of Infectology, 2023, Vol. 15, No. 1, рр. 159–160 (In Russ.).