Resumen
Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this
therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected
adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018
mortality by causes was analyzed in a population-based cohort of adults aged 25 to 74 years diagnosed
with HIV infection in Spain. Observed deaths and expected deaths according mortality in the general
population of the same sex and age were compared using standardized mortality ratios (SMRs). HIVinfected
people increased from 839 in 1999–2003 to 1059 in 2014–2018, median age increased from
37 to 47 years, the annual mortality rate decreased from 33.5 to 20.7 per 1000 person-years and the
proportion of HIV-related deaths declined from 64% to 35%. HIV-related mortality declined from 21.4 to
7.3 (p < 0.001), while non-HIV-related mortality remained stable: 12.1 and 13.4 per 1000, respectively.
Mortality decreased principally in persons diagnosed with AIDS-defining events. In the last decade, 2009–
2018, mortality was still 8.1 times higher among HIV-infected people than in the general population, and
even after excluding HIV-related deaths, remained 4.8 times higher. Excess mortality was observed in
non-AIDS cancer (SMR = 3.7), cardiovascular disease (SMR = 4.2), respiratory diseases (SMR = 7.9), liver
diseases (SMR = 8.8), drug abuse (SMR = 47), suicide (SMR = 5.3) and other external causes (SMR = 6).
In conclusion, HIV-related mortality continued to decline, while non-HIV-related mortality remained
stable. HIV-infected people maintained important excess mortality. Prevention of HIV infections in the
population and promotion of healthy life styles in HIV-infected people must be a priority.
Autoría:
FONTELA,Carmen;
AGUINAGA, Aitziber;
MORENO IRIBAS, María Concepción;
REPÁRAZ, Jesús;
RIVERO, María;
GRACIA, María;
FLORISTÁN, Yugo;
FRESÁN, Ujué;
SAN MIGUEL, Ramón;
EZPELETA, Carmen;
CASTILLA CATALÁN, Jesús