Trends in mortality among people with HIV in Mexico: Analysis of National Death Registries (1998-2022)

Objectives We aimed to describe the frequency of deaths related to advanced HIV disease (AHD) and its associated characteristics; and the frequency of very early (VEM) and early mortality (EM) after HIV diagnosis among people with HIV (PWH) in Mexico between 1998 and 2022. Methods We used the Mexican National Death Registry data. We defined deaths related to AHD as those listed in the CDCs AIDS-defining conditions, VEM as deaths occurring within the first month, and EM as those occurring between the first month and the first year after HIV–diagnosis. We used logistic regression models to describe trends of deaths related to AHD, EM, VEM and specific causes of death over time. Results There were 106,056 registered deaths among PWH, ranging from 507 to 5287 annually. The most common cause of death was deaths related to AHD throughout the study period (54%). The predicted probability of death related to AHD decreased from 75% to 35% between 2000 and 2012 but increased after 2014 up to 52% in 2022. Overall, 22% of deaths occurred very early and 25% early after HIV-diagnosis. Calendar year was the only strong predictor of death due to AHD. Conclusions A high and increasing proportion of deaths were attributed to advanced HIV disease in Mexico, a fifth of them occurred in the first month of HIV diagnosis, and almost a half in the first year. In the context of universal access to ART, these results suggest that additional components of the public health HIV response could be lacking.