Elevated risks of death for diabetes mellitus and cardiovascular diseases in Italian AIDS cases

HIV-infected people are at increasing risk of developing several non-AIDS defining illnesses, including diabetes mellitus (DM) and cardiovascular diseases [1-3]. Traditional risk factors (such as cigarette smoking, ageing, obesity, and viral co-infections) and duration of HIV infection are considered responsible of their elevated frequency, though they have also been associated with adverse effects of antiretroviral treatments [1,4-6]. Several studies have evaluated the incidence of DM and cardiovascular diseases in HIV-infected persons in the era of highly active antiretroviral therapies (HAART), and their impact as causes of death [7-10].By taking advantage of the population-based data used for assessing post-AIDS survival [11], we estimated the risk of death for DM, myocardial infarction, and chronic ischemic heart diseases among people with AIDS diagnosed between 1999 and 2005. The original study design and the main characteristics of study subjects were previously described [11]. Briefly, in Italy AIDS cases are diagnosed according to the 1993 revised European AIDS definition [12], and they are compulsorily reported to the national AIDS registry (RNAIDS), a comprehensive surveillance system formerly described in detail [13]. Under-reporting of people with AIDS (PWA) has been estimated at about 5% [14], whereas the vital status of PWA is not routinely kept up-to-date. The updated vital status of PWA was sought for in the Italian Mortality Database at the Italian National Institute of Statistics through a record linkage procedure. Data regarding PWA diagnosed in Italy from 1999 and 2005 were linked with data concerning the 4,420,498 deaths occurred between 1999 and 2006. After excluding non Italian citizens, pediatric cases, PWA diagnosed solely at autopsy who were residents in provinces where information on names were not available on deaths certificates, 9662 Italian adult PWA constituted the study population. Of these PWA, 3101 died. Conditions listed in the d