1. Mortality and cause of death among HIV patients in London in 2016
S.Croxford1, R. Miller2, F. Post3, J. Figueroa1,4, I. Harrison4, R. Harding3, V. Delpech1, S. Lucas5, S. Dhoot6 and A. Sullivan6 on behalf of the London Mortality Study Group
1 Public Health England, London, UK
2 CNWL NHS Foundation Trust, London, UK
3 King’s College Hospital NHS Foundation Trust, London, UK
4 NHS England, London, UK
5 Guys & St. Thomas NHS Foundation Trust, London, UK
6 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

2. Background & Methods
Objective: to better understand causes of death in HIV- positive people in the UK to ultimately reduce avoidable mortality
Retrospective review of deaths in London HIV patients
All London HIV care services submitted case-reports of all deaths among their patients occurring in 2016.
Data were submitted using a modified Causes of Death in HIV (CoDe) reporting form including information on: comorbidities, antiretroviral therapy (ART), clinical markers, cause of death and end of life care.
Cause of death was categorised by a pathologist and two clinicians.

3. Cause of death by whether the death was expected: London, 2016
Results
206 deaths: 77% men
Median age at death: 56 years
At death:
81% on ART
61% with a CD4<350 cells/mm3
24% with a VL ≥200 copies/ml
Risk factors in the year before death:
Smoking (37%)
Excessive alcohol consumption (19%)
Non-IDU (20%)
IDU (7%)
OST (6%)
36% of deaths unexpected
60% of expected deaths in hospital
Where cause of death (86%) was known, the majority of deaths were from non-AIDS cancers and AIDS.
Cause of death by whether the death was expected: London, 2016

4. Conclusions
In 2016, over three quarters (77%) of deaths were due to non-AIDS conditions and the majority of patients were on ART and virally suppressed at their last clinic visit.
However, a number of potentially avoidable deaths were identified, highlighting the need for improvement in testing rates, optimal management of comorbidities and strong psycho-social support.
The high proportion of expected deaths in hospital show improvements are necessary in end-of-life care planning and in collaborative decision making with patients and other specialties, such as oncology and cardiology.