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

## TL;DR

This study examines 20 years of HIV patient mortality in Israel, finding that while overall mortality decreased, non-AIDS-related deaths increased.

## Contribution

The study provides updated insights into mortality trends and risk factors for HIV patients in Israel during the modern ART era.

## Key findings

- Mortality rates decreased from 2.12% in 2005–2008 to 0.71% in 2018–2021.
- Non-AIDS-related deaths increased from 25% in 2001–2002 to 75% in 2019–2021.
- Low CD4, high viral load, non-MSM transmission, and non-compliance were significant risk factors for mortality.

## Abstract

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.