Background: The International Classification of Diseases (ICD) contains codes for adverse effects of antiviral drugs (abbreviated here as ADVER)--931.7 and E961.7 in ICD-9 and Y41.5 in ICD-10--but they do not specify the particular adverse effects. Objective: To determine which particular conditions were considered ADVER by physicians who completed death certificates of persons reported to have died with HIV infection.
Methods: All US death certificate records from 1987–1999 that reported HIV infection were analyzed. Among those that also reported ADVER, disease conditions reported in at least 5 deaths were identified. All those conditions and demographic characteristics associated with ADVER on univariate analysis by Fisher’s exact test were included as covariates in a multiple logistic regression model with ADVER as the response variable.
Results: Among the 387 190 persons whose death certificates reported HIV infection, 74 (0.02%) were reported with ADVER. The odds ratios (and 95% CI) for conditions significantly associated with ADVER in the regression model were: acute pancreatitis: 20.6 (11.7–36.3); acidosis: 11.8 (5.7–24.7), agranulocytosis: 8.9 (3.2–24.9), aplastic anemia: 8.6 (4.1–18.3), and renal failure: 4.8 (2.8–8.2).
Conclusions: The low proportion of deaths reported with ADVER may reflect under-reporting. By reducing the power of this study, the small numbers may have prevented discovery of other conditions associated with ADVER. Nonetheless, the conditions found to be associated with ADVER add to the growing dilemma in the management of HIV-infected patients between the risks of disease progression and the risks of adverse effects of therapy. More population-based data on potential adverse effects are needed to guide treatment recommendations.