Effect of the human immunodeficiency virus epidemic on mortality from opportunistic infections in the United States in 1993

To measure the effect of the human immunodeficiency virus (HIV) epidemic on mortality from opportunistic infections (OIs) in 1993, national multiple-cause death certificate data were examined using two approaches. First, for each OI, the percentage of deaths with HIV infection reported as the underlying cause was calculated. Second, the age-adjusted rate of death per million population was compared with the rate predicted from a model of rates in 1970-1980 or 1979-1981, as available. The percentage of deaths with HIV as the underlying cause and the ratio of observed to predicted death rates were as follows: toxoplasmosis, 91% and 86 (5.24/0.06); cryptosporidiosis/isosporiasis, 90% and infinite (1.61/0.00); progressive multifocal leukoencephalopathy, 87% and 19 (2.58/0.13); pneumocystosis, 82% and 18 (15.44/0.87); cytomegalovirus disease, 82% and 17 (12.60/0.74); nontuberculous mycobacteriosis, 79% and 18 (15.51/0.84); cryptococcosis, 76% and 4 (5.80/1.35); and histoplasmosis, 68% and 6 (1.36/0.23). Thus, the HIV epidemic has greatly increased mortality from several OIs.