Background
Antiretroviral therapy (ART) has significantly reduced AIDS-related deaths, yet death rates remain higher among people living with HIV (PLHIV) compared with individuals without HIV. This has been partly attributed to a higher risk of non-communicable diseases (NCDs) among PLHIV. Providing insights into NCDs’ contribution to the cause of death among PLHIV will guide priority setting for the reduction of mortality amongst them.
Methods
Between August 2021 and October 2024, verbal autopsy (VA) data for 11,239 deceased PLHIVs from 657 ART facilities in 33 states was collected from the Nigeria HIV Mortality Surveillance database. Causes of death (COD) were determined using the SmartVA-Analyze (Tariff 2.0 algorithm), and descriptive data analysis was performed in Microsoft Excel
Results
VA data determined the COD for 11,239 PLHIVs, comprising 6,245 (55.6%) females and 4,994 (44.4%) males. The leading COD was AIDS, accounting for 3,313 deaths (29.5%), followed by non-communicable diseases at 2,136 (19.0%). The most common NCDs were stroke (551; 25.8%), acute myocardial infection (424; 19.9%), diabetes (356; 16.7%), malignancy (265; 12.4%), and chronic kidney disease (235; 11.0%). Among (204: 17.1%) women with malignancies, breast cancer 131; 6.1%) and cervical cancer (26; 1.2%) were the most common. In men, prostate cancer (18; 0.8%) and stomach cancer (6; 0.3%) were most prevalent. For adults aged 15+, the leading NCDs included stroke (550; 25.3%), acute myocardial infection (423; 19.4%), diabetes (356; 16.4%), chronic kidney diseases (229; 10.5%), breast cancer (131; 6.0%) and cirrhosis (126; 5.8%). In the pediatric group (<15), the main causes were digestive diseases (38; 82.6%), childhood cancer (33; 71.7%), chronic kidney disease (6; 13.0%) and other non-communicable diseases (2; 4.3%).
Conclusions
This work highlights the importance of closely monitoring the causes of death among PLHIV. Information on mortality trends for PLHIV would guide the implementation of fit-for-purpose interventions to prevent avoidable deaths. Ultimately, these targeted interventions can support the provision of appropriate standards of care, thereby improving their treatment outcomes and reducing mortality rates amongst HIV-positive individuals.