Table 1.

Characteristic	Total		HIV-related*				Non–HIV-related*
Characteristic	No.	Age-adjusted rate per 1,000 PWDH^†	No.	% of deaths related to HIV	% of deaths with known cause related to HIV	Age-adjusted rate per 1,000 PWDH^†	No.	Age-adjusted rate per 1,000 PWDH^†
Gender
Male	12,256	13.5	4,033	32.9	34.1	4.5	7,779	8.5
Female	3,994	14.1	1,466	36.7	37.7	5.4	2,425	8.3
Transgender male-to-female^§	103	14.8	33	32.0	32.4	4.3	69	10.2
Transgender female-to-male^§	4	18.0	2	50.0	50.0	10.7	2	7.3
Additional gender identity^¶	1	13.8	0	0	0	0	1	13.8
Age at death, yrs
13–24	151	3.5	70	46.4	48.6	1.6	74	1.7
25–34	1,048	6.5	492	46.9	48.8	3.0	516	3.2
35–44	1,838	9.4	826	44.9	46.4	4.2	954	4.9
45–54	4,470	14.4	1,584	35.4	36.6	5.1	2,740	8.9
≥55	8,851	28.9	2,562	28.9	30.0	8.4	5,992	19.5
Race/Ethnicity
American Indian/Alaska Native	44	13.5	8	18.2	21.1	3.3	30	8.3
Asian**	88	6.3	27	30.7	39.1	1.5	42	3.1
Black/African American	7,197	15.1	2,620	36.4	37.3	5.6	4,412	9.2
Hispanic/Latino^††	2,694	11.1	955	35.4	37.2	3.9	1,609	6.6
Native Hawaiian/Other Pacific Islander**	9	15.0	0	0	0	0	2	2.5
White	5,255	13.3	1,546	29.4	30.5	3.9	3,520	8.9
Multiple races	1,069	19.5	378	35.4	36.5	7.0	659	12.0
Transmission category^§§
Male adult or adolescent^¶¶
Male-to-male sexual contact	7,010	11.4	2,408	34.4	35.6	3.9	4,351	7.1
Injection drug use	2,168	22.7	590	27.2	28.1	6.2	1,506	15.8
Male-to-male sexual contact and injection drug use	1,373	19.1	444	32.4	33.3	6.1	889	12.6
Heterosexual contact***	1,705	16.1	579	34.0	35.6	5.8	1,046	9.5
Other^†††	104	19.0	44	42.4	43.4	6.6	57	11.9
Subtotal	12,360	13.5	4,066	32.9	34.1	4.5	7,849	8.5
Female adult or adolescent^¶¶
Injection drug use	1,373	21.6	454	33.0	33.7	7.7	893	13.1
Heterosexual contact***	2,553	12.0	974	38.2	39.3	4.6	1,506	7.1
Other^†††	72	16.2	40	56.2	59.6	7.0	27	8.9
Subtotal	3,998	14.1	1,468	36.7	37.7	5.4	2,427	8.3
U.S. Census region of residence at time of death
Midwest	1,901	14.1	602	31.7	32.3	4.4	1,263	9.4
Northeast	3,689	12.0	941	25.5	26.8	3.2	2,576	8.2
South	8,040	15.5	3,092	38.5	39.1	6.0	4,822	9.2
West	2,728	11.4	899	33.0	35.8	3.9	1,615	6.6
Total	16,358	13.6	5,534	33.8	35.0	4.7	10,276	8.5

Table 1. Total deaths, human immunodeficiency virus (HIV)–related deaths, and non–HIV-related deaths among persons aged ≥13 years with diagnosed HIV infection, by selected characteristics — United States, 2017

Abbreviation: PWDH = persons with diagnosed HIV infection.
* HIV-related deaths include deaths with an underlying cause with an International Classification of Diseases, Tenth Revision code of B20–B24, O98.7, or R75. Non–HIV-related deaths include all other deaths with a known underlying cause. Deaths with an unknown underlying cause are excluded.
^† PWDH includes persons living with HIV infection at the end of the calendar year plus the number of diagnoses of HIV infection during the current calendar year. Rates age-adjusted using the U.S. 2000 standard population. Rates presented by age at time of death are not age-adjusted. Rates and percentage change calculated on the basis of <12 deaths are considered unstable and should be interpreted with caution.
^§ “Transgender male-to-female” includes persons who were assigned “male” sex at birth but have ever identified as “female.” “Transgender female-to-male” includes persons who were assigned “female” sex at birth but have ever identified as “male.”
^¶ Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
** Data by cause of death should be interpreted with caution because <85% of reported deaths were reported with a known underlying cause of death.
^†† Hispanic/Latino persons can be of any race.
^§§ Data have been statistically adjusted to account for missing transmission category; therefore, values might not sum to column subtotals and total.
^¶¶ Data presented are based on sex at birth and include transgender persons.
*** Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^††† Includes hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified.

Table 2.

Area of residence	All races/ethnicities			Black/African American				Hispanic/Latino				White
	Total			Total		HIV-related^†		Total		HIV-related^†		Total		HIV-related^†
	No.	Age-adjusted rate per 1,000 PWDH^§	% of deaths with a known cause	No.	Age-adjusted rate per 1,000 PWDH^§	No.	Age-adjusted rate per 1,000 PWDH^§	No.	Age-adjusted rate per 1,000 PWDH^§	No.	Age-adjusted rate per 1,000 PWDH^§	No.	Age-adjusted rate per 1,000 PWDH^§	No.	Age-adjusted rate per 1,000 PWDH^§
Alabama	257	17.8	98.4	150	17.5	60	6.5	5	11.4	2	5.2	83	19.5	29	6.1
Alaska	7	8.5	100.0	0	0	0	0	1	11.8	0	0	5	14.0	1	1.6
Arizona	247	13.5	99.6	29	14.9	10	6.1	56	12.3	26	6.2	145	14.7	48	4.6
Arkansas	107	17.0	99.1	33	12.3	16	6.2	6	15.7	3	7.9	61	19.2	21	6.5
California	1,717	11.0	89.7	327	12.1	118	4.4	509	10.2	195	3.9	724	10.4	193	2.8
Colorado	132	8.4	100.0	13	5.9	6	2.8	33	12.2	12	4.9	77	7.2	33	3.1
Connecticut	198	15.0	99.5	72	14.7	18	4.9	57	12.6	15	3.7	64	18.8	16	4.0
Delaware	67	13.8	100.0	50	18.0	13	4.6	4	13.6	1	3.8	11	6.5	1	0.5
District of Columbia	237	13.4	97.0	202	16.2	59	5.3	3	3.5	1	1.2	14	4.6	2	0.6
Florida	2,122	15.6	98.4	1,049	17.5	424	7.2	329	11.0	124	4.1	683	16.2	199	4.7
Georgia	823	14.5	97.7	559	15.3	244	6.5	43	12.5	18	4.2	158	12.0	38	2.9
Hawaii^¶	37	15.2	35.1	1	5.6	0	0	1	3.3	1	3.3	12	7.0	2	0.8
Idaho	20	13.6	100.0	0	0	0	0	1	2.6	1	2.6	17	16.4	6	5.8
Illinois	498	12.8	99.2	289	16.6	76	4.4	48	7.3	14	1.8	124	11.2	30	2.1
Indiana	212	17.1	97.2	66	15.7	20	5.4	10	10.6	6	6.4	126	20.3	44	5.6
Iowa	44	13.1	100.0	11	16.9	6	9.7	3	7.0	1	2.3	26	11.3	10	4.4
Kansas	47	14.4	97.9	11	16.0	7	11.1	6	10.8	2	2.1	29	14.1	12	5.1
Kentucky	138	16.4	97.8	44	17.0	17	6.3	5	6.4	3	3.9	82	16.8	24	4.8
Louisiana	411	18.5	98.8	276	19.0	125	8.8	7	5.8	1	0.7	115	19.8	34	6.3
Maine	35	15.6	100.0	1	2.5	0	0	2	12.0	1	4.9	31	19.0	7	5.9
Maryland	597	14.7	98.3	412	14.0	132	4.4	26	9.5	9	3.0	84	18.9	19	3.8
Massachusetts	307	11.6	96.1	64	8.3	14	2.6	90	13.1	27	4.2	144	13.7	33	2.8
Michigan	273	15.6	99.3	160	17.2	49	5.1	13	14.9	4	3.2	88	12.5	27	3.8
Minnesota	91	9.3	98.9	27	8.3	15	4.0	6	6.9	3	2.1	52	10.2	19	4.2
Mississippi	220	21.2	98.6	158	22.1	85	11.5	9	36.7	6	21.3	44	19.3	12	5.5
Missouri	213	14.5	97.2	97	16.7	38	6.5	10	13.1	6	7.8	95	13.6	30	3.9
Montana	15	20.9	100.0	0	0	0	0	4	93.8	2	34.1	8	11.4	1	1.6
Nebraska	33	14.3	93.9	11	20.2	4	5.7	2	6.9	1	5.4	20	14.9	4	2.5
Nevada	174	16.1	97.7	50	20.5	19	8.2	23	9.6	9	3.4	90	15.9	26	4.6
New Hampshire	21	13.7	95.2	0	0	0	0	3	15.5	0	0	18	17.2	6	6.0
New Jersey	646	13.8	98.6	324	15.1	105	5.2	141	12.1	43	3.9	118	11.9	25	3.0
New Mexico	61	13.1	98.4	2	8.4	0	0	24	11.2	4	2.0	25	12.4	3	1.4
New York	1,787	10.7	98.3	661	10.7	164	3.0	635	11.0	170	3.0	247	7.2	59	1.9
North Carolina	547	15.1	98.9	338	15.3	137	6.1	19	7.9	8	3.5	152	15.1	48	4.6
North Dakota	3	8.9	100.0	0	0	0	0	1	131.2	1	131.2	2	8.7	1	4.4
Ohio	377	15.5	97.9	152	15.2	53	5.5	21	10.7	7	3.7	176	16.7	50	4.2
Oklahoma	109	16.8	95.4	22	13.5	11	7.1	6	8.9	1	1.0	65	20.3	22	7.5
Oregon	115	12.4	100.0	5	9.6	1	1.9	9	7.9	6	5.3	96	13.4	36	5.1
Pennsylvania^¶	650	14.5	81.8	301	14.4	55	2.5	105	14.7	21	3.0	202	14.4	34	2.4
Puerto Rico	401	19.1	99.0	0	0	0	0	400	19.1	181	9.2	1	21.9	0	0
Rhode Island	33	9.6	97.0	7	8.6	3	3.5	6	8.6	2	3.2	17	9.5	4	2.2
South Carolina	337	17.2	97.9	236	17.7	110	8.2	5	6.4	2	2.3	83	19.3	34	10.1
South Dakota^¶	9	12.4	33.3	2	9.1	1	3.9	0	0	0	0	4	10.0	0	0
Tennessee	332	18.2	99.4	189	19.9	81	7.7	6	9.2	2	3.2	128	17.3	48	5.8
Texas	1,413	15.1	98.9	557	17.3	245	7.4	359	12.8	182	6.5	409	14.6	157	5.8
Utah	22	8.4	95.5	1	4.2	1	4.2	3	9.8	0	0	16	7.0	8	3.4
Vermont	12	11.4	100.0	0	0	0	0	1	7.5	0	0	10	12.2	3	3.2
Virginia	292	10.5	98.3	180	11.8	60	4.1	9	3.3	6	2.1	79	9.0	27	3.2
Washington	175	10.4	97.1	24	10.8	9	4.2	19	9.3	6	2.8	112	10.8	35	3.8
West Virginia	31	13.8	100.0	4	7.5	1	2.1	1	11.9	0	0	24	15.8	6	4.6
Wisconsin	101	12.7	100.0	30	11.7	8	3.3	9	9.0	0	0	57	13.8	18	4.2
Wyoming^¶	6	27.2	66.7	0	0	0	0	0	0	0	0	3	9.5	1	3.5

Table 2. Total deaths and human immunodeficiency virus (HIV)–related deaths among persons aged ≥13 years with diagnosed HIV infection, by area of residence at time of death, and selected race/ethnicity categories — United States and Puerto Rico,* 2017

Abbreviation: PWDH = persons with diagnosed HIV infection.
* Other U.S. dependent areas are excluded because they do not report underlying cause of death information.
^† HIV-related deaths include deaths with an underlying cause with an International Classification of Diseases, Tenth Revision code of B20–B24, O98.7, or R75. Non–HIV-related deaths include all other deaths with a known underlying cause. Deaths with an unknown underlying cause are excluded.
^§ PWDH includes persons living with HIV infection at the end of the calendar year plus the number of diagnoses of HIV infection during the current calendar year. Rates age-adjusted using the U.S. 2000 standard population. Rates calculated based on consideration that analyses of data with <12 deaths are considered unstable and should be interpreted with caution.
^¶ Proportion of deaths with a known underlying cause of death is <85%.

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CME / ABIM MOC / CE

Vital Signs: Deaths Among Persons With Diagnosed HIV Infection, United States, 2010–2018

Authors: Karin A. Bosh, PhD; Anna Satcher Johnson, MPH; Angela L. Hernandez, MD; Joseph Prejean, PhD; Jocelyn Taylor, MPH; Rachel Wingard, MA; Linda A. Valleroy, PhD; H. Irene Hall, PhD
CME / ABIM MOC / CE Released: 4/30/2021
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 4/30/2022

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Target Audience and Goal Statement

This activity is intended for public health officials, infectious disease clinicians, hematologists, immunologists, internists, and other clinicians caring for patients with HIV infection.

The goal of this activity is to describe changes in age-adjusted death rates per 1000 persons with diagnosed HIV (PWDH) during 2010-2018, according to a Centers for Disease Control and Prevention (CDC) analysis of National HIV Surveillance System (NHSS) data for persons aged ≥ 13 years, emphasizing HIV-related deaths, at the national and state levels.

Upon completion of this activity, participants will:

Describe changes in age-adjusted death rates per 1,000 persons with diagnosed HIV infection (PWDH) during 2010–2018, overall and in racial/ethnic subgroups, according to a CDC analysis of National HIV Surveillance System (NHSS) data for persons aged ≥13 years
Describe age-adjusted HIV-related death rates per 1,000 PWDH during 2010–2017 in sociodemographic subgroups, according to a CDC analysis of NHSS data for persons aged ≥13 years
Identify clinical implications of changes in age-adjusted death rates per 1,000 PWDH during 2010–2018, overall and in various subgroups, according to a CDC analysis of NHSS data for persons aged ≥13 years

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Faculty

Karin A. Bosh, PhD

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Karin A. Bosh, PhD, has disclosed no relevant financial relationships.

Anna Satcher Johnson, MPH

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Anna Satcher Johnson, MPH, has disclosed no relevant financial relationships.

Angela L. Hernandez, MD

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Angela L. Hernandez, MD, has disclosed no relevant financial relationships.

Joseph Prejean, PhD

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Joseph Prejean, PhD, has disclosed no relevant financial relationships.

Jocelyn Taylor, MPH

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Jocelyn Taylor, MPH, has disclosed no relevant financial relationships.

Rachel Wingard, MA

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Rachel Wingard, MA, has disclosed no relevant financial relationships.

Linda A. Valleroy, PhD

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: Linda A. Valleroy, PhD, has disclosed no relevant financial relationships.

H. Irene Hall, PhD

Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia

Disclosures

Disclosure: H. Irene Hall, PhD, has disclosed no relevant financial relationships.

CME Author

Laurie Barclay, MD

Freelance writer and reviewer
Medscape, LLC

Disclosures

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

Associate Director, Accreditation and Compliance Medscape, LLC

Disclosures

Disclosure: Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE, has disclosed no relevant financial relationships.

CE Reviewer

Esther Nyarko, PharmD

Associate Director, Accreditation and Compliance Medscape, LLC

Disclosures

Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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From Morbidity & Mortality Weekly Report

CME / ABIM MOC / CE

Vital Signs: Deaths Among Persons With Diagnosed HIV Infection, United States, 2010–2018

Authors: Karin A. Bosh, PhD; Anna Satcher Johnson, MPH; Angela L. Hernandez, MD; Joseph Prejean, PhD; Jocelyn Taylor, MPH; Rachel Wingard, MA; Linda A. Valleroy, PhD; H. Irene Hall, PhDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 4/30/2021

Valid for credit through: 4/30/2022

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Abstract and Introduction

Abstract

Background. Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population, yet HIV remains among the 10 leading causes of death among certain populations. Using surveillance data, CDC assessed progress toward reducing deaths among persons with diagnosed HIV (PWDH).

Methods. CDC analyzed National HIV Surveillance System data for persons aged ≥13 years to determine age-adjusted death rates per 1,000 PWDH during 2010–2018. Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non–HIV-related. Temporal changes in total deaths during 2010−2018 and deaths by cause during 2010–2017 (2018 excluded because of delays in reporting), by demographic characteristics, transmission category, and U.S. Census region of residence at time of death were calculated.

Results. During 2010–2018, rates of death decreased by 36.6% overall (from 19.4 to 12.3 per 1,000 PWDH). During 2010–2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7), whereas non–HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2).

Conclusion. Early diagnosis, prompt treatment, and maintaining access to high-quality care and treatment have been successful in reducing HIV-related deaths and remain necessary for continuing reductions in HIV-related deaths.

Introduction

Persons with human immunodeficiency virus (HIV) infection require lifelong treatment to reduce HIV-related morbidity and mortality; advances in HIV treatment have resulted in a life expectancy that approaches that of the general population ^[1,2]. Deaths attributable to HIV infection are preventable, yet during 2017, HIV was still among the 10 leading causes of death among certain population groups ^[3].

The National HIV Surveillance System (NHSS) is the primary source of population-based information about HIV in the United States ^[4]. A previous analysis demonstrated that, during 1990–2011, deaths among persons with stage 3 HIV infection (acquired immunodeficiency syndrome [AIDS]) decreased, with larger decreases in HIV-attributable deaths (−89%) than in non–HIV-attributable deaths (−57%) ^[5]. On the basis of increasing evidence of the benefits of antiretroviral therapy both for persons with HIV and for preventing secondary transmission, treatment guidelines were updated in 2012 to recommend antiretroviral therapy for all persons with HIV ^[6]. A national target for reducing the death rate among persons with diagnosed HIV (PWDH) by ≥33% during 2010–2020 was established to encourage progress toward improving health outcomes among PWDH ^[7]. Using NHSS data, CDC assessed such progress, with an emphasis on HIV-related deaths, at the national and state levels.

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Methods

CME / ABIM MOC / CE Information

Abstract and Introduction
Methods
Results
Discussion
Summary

Disclaimer

The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

Table 1.

Table 2.

References

Faculty and Disclosures

Faculty

Karin A. Bosh, PhD

Anna Satcher Johnson, MPH

Angela L. Hernandez, MD

Joseph Prejean, PhD

Jocelyn Taylor, MPH

Rachel Wingard, MA

Linda A. Valleroy, PhD

H. Irene Hall, PhD

CME Author

Laurie Barclay, MD

CME Reviewer/Nurse Planner

Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

CE Reviewer

Esther Nyarko, PharmD

CME / ABIM MOC / CE

Vital Signs: Deaths Among Persons With Diagnosed HIV Infection, United States, 2010–2018

Target Audience and Goal Statement

Disclosures

Faculty

Karin A. Bosh, PhD

Anna Satcher Johnson, MPH

Angela L. Hernandez, MD

Joseph Prejean, PhD

Jocelyn Taylor, MPH

Rachel Wingard, MA

Linda A. Valleroy, PhD

H. Irene Hall, PhD

CME Author

Laurie Barclay, MD

CME Reviewer/Nurse Planner

Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

CE Reviewer

Esther Nyarko, PharmD

Accreditation Statements

For Physicians

For Nurses

For Pharmacists

Instructions for Participation and Credit

Vital Signs: Deaths Among Persons With Diagnosed HIV Infection, United States, 2010–2018

Abstract and Introduction

Abstract

Introduction

Table of Contents