Updated mortality and causes of death in 2020-2021 in people living with HIV: a multicenter study in France.

OBJECTIVE: To assess updated mortality and causes of death in people living with HIV (PLWH) in France.

DESIGN AND METHODS: We analyzed all deaths in PLWH followed up between 01/01/2020 and 31/12/2021 in 11 hospitals in the Paris region. We described the characteristics and causes of death among deceased PLWH, and evaluated the incidence of mortality and associated risk factors using a multivariate logistic regression.

RESULTS: Of the 12942 patients followed in 2020-2021, 202 deaths occurred. Mean annual incidence of death (95% confidence interval [CI]) was 7.8 per 1 000 PLWH (6.3-9.5). Forty-seven patients (23%) died from non-AIDS non-viral hepatitis (NANH)-related malignancies, 38 (19%) from non-AIDS infections (including 21 cases of COVID-19), 20 (10%) from AIDS, 19 (9%) from cardiovascular diseases (CVD), 17 (8.4%) from other causes, six (3%) from liver diseases and five (2.5%) from suicides/violent deaths. The cause of death was unknown in 50 (24.7%) patients. Risks factors for death were age (adjusted Odds Ratio (aOR) 1.93; 1.66-2.25 by additional decade), AIDS history (2.23; 1.61-3.09), low CD4 (1.95; 1.36-2.78 for 200-500/μL and 5.76; 3.65-9.08 for ≤ 200/μL versus > 500/μL), and viral load > 50 copies/mL (2.03; 1.33-3.08), both at last visit.

CONCLUSIONS: NANH malignancies remained in 2020-2021 the first cause of death. COVID-19 accounted for more than half of the mortality related to non-AIDS infections over the period. Aging, AIDS history, and a poorer viro-immunological control were associated with death.