Mortality among antiretroviral-eligible patients in an urban public clinic

Background: Advances in antiretroviral therapy (ART) over the last decade have improved clinical outcomes for people living with human immunodeficiency virus (HIV), but whether these improvements are experienced by disadvantaged urban populations is less clear. Methods: We evaluated mortality among a clinical cohort in a public safety-net HIV specialty clinic in San Francisco, California. Results: Among 1651 ART-eligible patients attending an urban US HIV clinic, 4-year mortality was 10.0% in 2000-2004 and 11.0% in 2005-2009. Despite universal ART availability, only 72 (42%) of 172 patients who died, compared with 69% of survivors, ever achieved an HIV viral load, 400 copies per cubic millimeter. The leading causes of death were acquired immunodeficiency syndrome (56%), violence/overdose (16%), and pulmonary disease (6%). Conclusions: Disadvantaged subpopulations in the developed world can experience high mortality rates despite accessing specialty HIV clinical services with full ART availability. New strategies are needed to improve the outcomes in these populations.