Аnalysis of lethal cases in patients with HIV infection based on the experience of Voronezh regional aids clinical center

Despite the organizational and preventive measures, the prevalence of HIV infection continues to increase in Russian Ferderation. The course of the disease is exacerbated by comorbidities such as tuberculosis and chronic hepatitis. This requires a special approach to treatment. The increase in the number of comorbid cases, insufficient screening coverage in risk groups have an impact on the progression of HIV and cause an increase in mortality both in the Russian Federation and Voronezh region over the past decade. Researchers note that many patients died from mycobacterial infections, pneumonia, lymphomas, and other somatic diseases during the first year after diagnosis.
The aim of the study. Conduct a comparative analysis of the social, demographic, and medical characteristics, as well as the causes of death, of patients with HIV infection between 2013 and 2023. Materials and methods. A complete sample was selected from medical records of 120 patients who were admitted to the Voronezh Regional AIDS Prevention and Control Center clinic and died during that time period. Statistical analysis was performed using Excel 2019 and included calculation of the Student’s t-test (p<0.05) and Spearman’s rank correlation coefficient.
Results and discussion. For the period under study 2013 and 2023 the highest percentage of deaths were observed in the age group from 31 to 40 years old in 2013 and 2023 — 41,7% and 43,3%, respectively, as well as in the age group of 41 to 50 years, which was 23,3% and 43,3%. Both groups were predominantly male, but by 2023 the proportion of young women had increased from 31,7% to 40%, increasing the demographic significance of the problem. Although in the Voronezh region, as well as in the Russian Federation as a whole, HIV infection is mainly transmitted through the sexual contact, our study revealed a high prevalence of patients with experience in places of deprivation of liberty who use drugs and alcohol, highlighting the need for in-depth monitoring and interdisciplinary study of these issues. In the mortality structure, it is necessary to note first of all a significant increase in HIV infection rate, as main cause of death from 11,7 to 25%, an increase in mortality due to external causes from 20% to 25%, and also a decrease in mortality from tuberculosis (TB): from 28,3% to 15%, bacterial infections (extra-hospital bilateral pneumonia and its complications): 11,7% to 8,3%; somatic diseases: 20% to 15%, chronic viral hepatitis C (HCV) in the stage of liver cirrhosis: 8,3% to 6,6%. The negative trend in HIV mortality is due to a number of reasons: improved approaches to clarifying and detailing causes of death have allowed us to better define the role of HIV infection and opportunistic infections (OI). New diagnostic techniques, including telemedicine consultations, could also be introduced. The increase in HIV and AIDS is thought to be related to improved awareness of symptoms and signs of these diseases, leading to earlier diagnosis and lower mortality. However, more research is needed to better understand the causes. Among the somatic diseases that have been the cause of death, an increase in mortality from oncological diseases has been noted (doubling from 3,3% to 6,6%). There were no changes in the mortality rate from cardiovascular disease, but a decrease in mortality from gastrointestinal diseases from 5% to 1,7%. In the group of diseases registered as background pathology, hepatitis C were frequently observed in liver cirrhosis (increase by 11,7% in 2023), gastrointestinal trac diseases (increase by 5% in 2023), nervous system (NS) (increase by 7,3% in 2023) and etc. In contrast to the main group, people living with HIV (PLHIV) between 31 and 50 years of age showed an increase in somatic diseases as a major cause of death (by 2,5%), while the main group decreased by 5%. The increase in mortality from HIV infection and OI from 2013 to 2023 was significantly lower: by 14,3% in the main group and by 2,9% in the age group 31–50 years. The number of deaths from bacterial infections doubled in this group, while the main group showed a decrease. In contrast to the main group, PLHIV at age 31–50 years was observed an increase of somatic diseases (by 2,5%) as the main cause of death while in the main group the same figure decreased by 5%.
Conclusion. Thus, this study provides information on the characteristics of PLHIV deaths, which is useful for understanding the mortality structure and designing measures to improve health. Further studies taking into account regional specificities will help to identify trends in the mortality structure and develop effective measures to improve health for people living with HIV

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