The HIV-positive population of the United Kingdom has a 6-times higher risk of death than the general population, despite the availability of free treatment and care, according to a recent study published in the Lancet.

Sara Croxford, MSc, from the Center for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom, and colleagues conducted an observational analysis using data from individuals older than 15 years of age who were diagnosed with HIV in England and Wales between 1997 and 2012. They examined mortality and causes of death in HIV-positive individuals in the era of highly active antiretroviral therapy compared with the general population.

A total of 88,994 individuals were diagnosed with HIV between 1997 and 2012, with 448,839 person-years of follow up. Overall, the mortality rate was 6% by the end of 2012 (all-cause mortality 118 per 10,000 person-years). The cause of death was determined for 91% of patients, and 58% of deaths were attributable to AIDS-defining illnesses.

The researchers found that late diagnosis was a strong predictor of mortality (hazard ratio [HR], 3.50), and that individuals who were diagnosed more recently had a lower risk of death (HR 2003-2007, 0.66; HR 2008-2012, 0.65).

The investigators also calculated standardized mortality ratios (SMR) to compare the mortality rates of the HIV-positive cohort to that of the general population. They found that the HIV-positive cohort mortality was higher than the general population for all causes (SMR, 5.7), non-AIDS infections (SMR, 10.8), and liver disease (SMR, 3.7).

“These findings highlight the importance of prompt diagnosis and linkage to care as major public health interventions to reduce premature mortality,” the study authors wrote. “HIV testing should be further expanded outside traditional settings to reach vulnerable populations and patients supported across the HIV care pathway. As people live longer with HIV, prevention and optimal management of comorbidities might further reduce mortality.”

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Croxford S, Kitching A, Desai S, et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet. 2016. doi:10.1016/S2468-2667(16)30020-2

This article originally appeared on Clinical Advisor