The shifting burden of mortality among men with HIV in Japan between 2007 and 2024: A single-center retrospective cohort study

Background Antiretroviral therapy (ART) has transformed HIV infection from a fatal disease into a chronic condition and improved the life expectancy of people living with HIV (PLWH). Few studies have examined long-term changes in standardized mortality ratios (SMRs) by age and cause of death among PLWH in Japan. This study investigated the changes in SMR among men with HIV infection in Japan over an 18-year period, focusing on age at death and the contribution of malignancies. Methods We conducted a retrospective cohort study of men with HIV infection who received care at Osaka National Hospital between 2007 and 2024. Data were extracted from medical records. Causes of death were classified according to the Coding Causes of Death in HIV protocol. SMRs were calculated based on the general male population of Japan. Results A total of 3,793 patients were included with 35,007 person-years of follow-up. The median age on enrollment was 36.3 years, and the median follow-up period was 10.1 years. Of the patients, 230 died during the study period, with a median age at death of 53.4 years. The causes of death included 44 deaths from AIDS-defining illnesses, 20 deaths from AIDS-related malignancies, 51 deaths from non-AIDS-related malignancies; and 57 deaths of unknown cause. The SMR decreased from 4.11 in 2007–2011 to 1.27 in 2021–2024, with different patterns in different age groups. The SMRs fell to below that of the general population (< 1.0) in the 20–39-years and ≥ 65-years age groups but remained high in the 40–64-years age group, and in patients with CD4 counts < 200 cells/µL or viral loads ≥ 1000 copies/mL within the calendar year. The SMR for malignancies also remained high in the 40–64-years age group (2.28 in 2021–2024). Conclusions Among men with HIV infection in Japan, the risk of mortality has markedly decreased with the widespread use of ART, approaching that of the general population, particularly in younger and older age groups. However, elevated mortality due to non-AIDS-related causes, particularly malignancies, persists among middle-aged men. Future HIV care should prioritize viral suppression and enhancing age-appropriate cancer screening.