• Vol. 41 No. 12, 571–576
  • 15 December 2012

Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010

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ABSTRACT

Introduction: Highly active antiretroviral therapy (HAART) has improved outcomes for individuals infected with human immunodeficiency virus (HIV). This study describes the causes of death in hospitalised HIV-positive patients from 2008 to 2010 in Tan Tock Seng Hospital, the national referral centre for HIV management in Singapore.

Materials and Methods: Data were retrospectively collected from HIV-positive patients who died in Tan Tock Seng Hospital from January 2008 to December 2010.

Results: Sixty-seven deaths occurred in the study period. A majority of patients died of non-acquired immune deficiency syndrome (AIDS)-defining illnesses (54.7%). The median CD4 count was 39.5 (range, 20.0 to 97.0), and 7 patients had HIV viral loads of <200 copies/mL. There were 27 deaths due to opportunistic infections, 27 due to non AIDS-defining infections, 4 due to non AIDS-associated malignancies. This study also describes 3 deaths due to cardiovascular events, and 1 due to hepatic failure. Patients who had virologic suppression were more likely to die from non AIDS-defining causes.

Conclusion: Causes of death in HIV-positive patients have changed in the HAART era. More research is required to further understand and address barriers to testing and treatment to further improve outcomes in HIV/AIDS.


The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency syndrome (AIDS)-defining illnesses (ADIs) in individuals infected with human immunodeficiency virus (HIV) in many countries. This has led to a paradigm shift in the management of HIV, from that of a highly lethal infection to a chronic condition. Consequently, mortality due to comorbid conditions is becoming more common. In spite of widespread access to HAART, the incidence of death due to ADIs is still high in some countries, especially when the infection is diagnosed late. It is important to have accurate data on the causes of mortality in the HIV-infected in both these settings, so as to develop better strategies aimed at early diagnosis and treatment, and management of non-AIDS conditions which might otherwise compromise prognosis. This study was undertaken to describe the distribution of the causes of death in hospitalised patients in our institution in Singapore. Tan Tock Seng Hospital (TTSH) is a 1481-bed teaching hospital in Singapore, which is also the national referral centre for HIV management.

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