Mortality Among HIV Patients in ISRAEL: A 20-Year Retrospective Cohort

The objectives of our study were to determine the mortality rates, causes, and risk factors of people living with HIV in the modern antiretroviral therapy era, in a major HIV center in Israel. We retrospectively collected data from 1547 patients treated during 2001-2021. We used the Shapiro-Wilk test, Fisher's exact test, Student's t test, and chi-square to compare between patients who died and those who did not, and between patients who died from AIDS-related and non-AIDS-related causes. In total, 206 (13.3%) patients died. The causes of death were AIDS-defining diseases (33.5%), cardiovascular diseases (21.8%), non-AIDS infections (16%), and hepatic disorders (7%). The annual mortality rate was 1.31 ± 0.3%. Despite an increase in age (35 ± 13.2 in 2001, 49 ± 13.6 years in 2021; p < 0.001), the mortality rate decreased (2.12% during 2005-2008, 0.71% during 2018-2021; p = 0.0001). AIDS-defining diseases caused 75% of deaths during 2001-2002, and only 25% during 2019-2021. The proportion of cardiovascular deaths increased (8.3% in 2001-2003, 33.3% in 2019-2021; p < 0.001). Low CD4 and high viral load at diagnosis, male gender, non-MSM HIV acquisition (heterosexual transmission and people who inject drugs), and inability to achieve viral suppression because of non-compliance were risk factors for mortality. Mortality rates decreased during 2001-2021; however, the proportion of non-AIDS deaths increased. Early cardiovascular comorbidity screening and targeted adherence interventions in non-MSM populations and in patients with low CD4 are needed.