- Researchers in Alberta reviewed health information on 3,001 people with HIV
- Between 2010 and 2022, deaths from self-harm, violence and drug poisoning greatly increased
- Comprehensive interventions are needed from all levels of government to reverse this trend
Thanks to the power of HIV treatment (antiretroviral therapy; ART), researchers expect that many people with HIV will live well into their senior years. However, ART cannot resolve issues unrelated to HIV, such as comorbidities. These other issues require attention and care.
Researchers at the Southern Alberta Clinic in Calgary reviewed their database on health-related information from 3,001 people with HIV. This information was collected between 2010 and 2022. The researchers found that, overall, the proportion of people who died from any cause decreased slightly from 1.5% in 2010 to 1.2% in 2021.
However, the causes of death changed over time. For instance, in 2010 more than 50% of all deaths were related to HIV. By 2020, the proportion of such deaths had fallen to 14%; many of those deaths were either caused by AIDS-related infections or cancers.
After 2010, as AIDS-related deaths decreased, deaths from cardiovascular disease—heart attack and stroke—increased, as did cancers unrelated to HIV. Most of these deaths were in older people with HIV.
What is striking is the change in deaths related to self-harm, violence or poisoning of the drug supply. In 2010, there was only one death (4%) from such causes. In 2021, nearly 39% of all deaths were from these causes.
Over the course of the entire study, the causes of death in people with HIV were as follows:
- 71 people died from complications of substance use or poisoning of the drug supply
- 16 people died from accidents or violence
- 7 people died from self-harm
People who were Indigenous (vs. non-Indigenous) were more likely to die from self-harm, violence or a poisoned drug supply; this also was the case with people who used drugs (vs. people who did not use drugs).
Where did deaths occur?
Overall, 61% of deaths occurred in a hospital (emergency or other departments), hospice or long-term care facility. Many of the remaining deaths took place in a home or residence. However, 25% of overall deaths happened outside of these settings. According to researchers, many deaths that were related to self-harm, violence and a poisoned drug supply occurred in an “alley, park or stairwell.” Although the researchers did not provide the sex distribution of participants, they did state that a person’s sex did not affect the place where death occurred.
On average, people who were older (57 years) died in a hospice or long-term care facility, while people who died in other places tended to be younger (37 years).
Future planning is needed to provide care to people with HIV who are aging and who wish to die at home and avert deaths unrelated to HIV.
The increase in deaths related to complications of drug use and a poisoned drug supply is deeply disheartening and requires intervention from all levels of government. Such interventions can help ensure that people who use drugs live longer and healthier lives, receiving the full spectrum of care and services that they need. Culturally appropriate interventions are also needed to help Indigenous people with HIV cope with trauma and the effects of racism and colonialism so that they can thrive and have a similar life expectancy to non-Indigenous people.
Bear in mind
Since 2010, there have been changes in the cause and location of deaths of people with HIV in this and other studies. Deaths related to HIV have declined (as found in studies from other high-income countries), while deaths related to comorbidities such as cardiovascular disease and cancer have increased. These deaths from comorbidities are likely related to aging in many cases.
In the present study, the average age of death from HIV-related causes was 47 years, while the average age of those who died from cardiovascular disease or cancer was 59 years. People who died from self-harm, violence or a poisoned drug supply were an average of 46 years old. In contrast, the average age of death among HIV-negative people in Alberta was 81 years in 2020.
Across Canada and Alberta, deaths from poisoning of the drug supply have increased tremendously over the past decade. Turning the tide against such deaths will require sustained intervention. Investments in harm reduction, mental health and other issues relevant to the well-being of people who use drugs will be needed.
Among older people, there was a trend to more deaths away from a hospital. This may mean that healthcare providers and their patients need to have discussions about end-of-life care and related issues. Resource planning is also required if more people wish to die in their homes rather than in hospitals or hospices.
The research team did not have access to socio-economic and other data, such as levels of education, income, smoking, mental health, housing stability, access to food and so on. Such factors can affect a person’s survival and their options for end-of-life care.
Although the data from the study may seem relatively small, they reflect larger trends that are happening across Canada and in some other high-income countries. The study draws attention to pressing issues that require discussion within ministries of health and clinics as well as between healthcare providers and patients.
Great strides have been made in helping people with HIV reduce their risk for AIDS-related infections. Many people with HIV who are taking ART now live into their senior years. The Alberta study is a timely reminder that some people with HIV require additional support so that the full benefits of ART are realized among all populations.
—Sean R. Hosein
REFERENCE:
Krentz HB, Lang R, McMillian J, et al. The changing landscape of both causes and locations of death in a regional HIV population 2010-2021. HIV Medicine. 2024; in press.