Trends in Mortality Among People With HIV in Mexico: Analysis of National Death Registries (1998-2022).

Background: We aimed to describe the frequency of deaths related to advanced HIV disease (AHD) and its associated characteristics, as well as the frequency of very early and early mortality after HIV diagnosis, among people with HIV in Mexico between 1998 and 2022. Methods: We used data from the Mexican National Death Registry. We defined deaths related to AHD as those listed in the AIDS-defining conditions of the Centers for Disease Control and Prevention, very early mortality as deaths occurring within the first month after HIV diagnosis, and early mortality 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, early mortality, very early mortality, and specific causes of death over time. Results: There were 106 056 registered deaths among people with HIV, ranging from 507 to 5287 annually. The most common cause of death was 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 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 antiretroviral therapy, these results suggest that additional components of the public health HIV response could be lacking.