Prevalence and Correlates of Untreated Human Immunodeficiency Virus Type 1 Infection among Persons Who Have Died in the Era of Modern Antiretroviral Therapy

We evaluated all human immunodeficiency virus (HIV)-related deaths over the period 1 January 1995-31 December 2001 in a Canadian province in which all HIV care and antiretroviral therapy are provided free of charge. Persons who had received antiretroviral drugs before death were compared with those who had died without ever receiving HIV treatment, by fitting a logistic model. Overall, 1239 deaths were attributed to HIV infection during the study period. Of these, 406 (32.8%) occurred among persons who had never received any HIV treatment. In adjusted analyses, aboriginal ethnicity, female sex, and lower median income were negatively associated with receiving HIV treatment before death. Furthermore, among the 833 individuals who received treatment before death, only 379 (45.5%) received antiretroviral medication >or=75% of the time during their first year receiving therapy. The data demonstrate the need for novel interventions to expand HIV care to specific populations.