Unrecognised HIV related deaths.

Area of Science:

• Epidemiology
• Public Health Surveillance

Background:

• Accurate reporting of Human Immunodeficiency Virus (HIV) infections is crucial for public health surveillance.
• Understanding undiagnosed HIV cases at the time of death is important for assessing the true burden of the epidemic and informing public health interventions.

Purpose of the Study:

• To determine if following up deaths from selected HIV-related causes could enhance HIV case reporting to the Public Health Laboratory Service Communicable Disease Surveillance Centre (CDSC).
• To estimate the proportion of deaths among HIV-positive men that occurred in individuals whose HIV status was not documented on the death certificate.

Main Methods:

• A follow-up study was conducted on draft death entries in England and Wales (February-July 1989) where one of 11 specified HIV-related causes was listed.
• Letters were sent to individuals who signed death certificates, requesting information on men known to be HIV-positive but not yet reported to the CDSC.

Main Results:

• Replies were received for 473 deaths (86%).
• Of the excess deaths attributed to HIV-related causes, a substantial percentage (35% for medical causes, 93% for external causes) occurred in individuals whose HIV status was unknown to the certifier.
• Only a small number of previously unreported HIV-positive cases were identified through this method.

Conclusions:

• Following up death registrations is an inefficient method for increasing HIV case reporting to the CDSC.
• A significant proportion of HIV-positive individuals with specific stated causes of death may not have had their HIV status diagnosed prior to death.
• These findings suggest potential underdiagnosis of HIV and have implications for patient care and postmortem examinations.