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Survival After AIDS Diagnosis in Italy, 1999-2006: A Population-Based Study. J Acquir Immune Defic Syndr 2009; 52:99-105. [DOI: 10.1097/qai.0b013e3181a4f663] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Early prediction of median survival among a large AIDS surveillance cohort. BMC Public Health 2007; 7:127. [PMID: 17597532 PMCID: PMC1925077 DOI: 10.1186/1471-2458-7-127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 06/27/2007] [Indexed: 11/10/2022] Open
Abstract
Background For individuals with AIDS, data exist relatively soon after diagnosis to allow estimation of "early" survival quantiles (e.g., the 0.10, 0.15, 0.20 and 0.30 quantiles, etc.). Many years of additional observation must elapse before median survival, a summary measure of survival, can be estimated accurately. In this study, a new approach to predict AIDS median survival is presented and its accuracy tested using AIDS surveillance data. Methods The data consisted of 96,373 individuals who were reported to the HIV/AIDS Reporting System of the California Department of Health Services Office of AIDS as of December 31, 1996. We defined cohorts based on quarter year of diagnosis (e.g., the "931" cohort consists of individuals diagnosed with AIDS in the first quarter of 1993). We used early quantiles (estimated using the Inverse Probability of Censoring Weighted estimator) of the survival distribution to estimate median survival by assuming a linear relationship between the earlier quantiles and median survival. From this model, median survival was predicted for cohorts for which a median could not be estimated empirically from the available data. This prediction was compared with the actual medians observed when using updated survival data reported at least five years later. Results Using the 0.15 quantile as the predictor and the data available as of December 31, 1996, we were able to predict the median survival of four cohorts (933, 934, 941, and 942) to be 34, 34, 31, and 29 months. Without this approach, there were insufficient data with which to make any estimate of median survival. The actual median survival of these four cohorts (using data as of December 31, 2001) was found to be 32, 40, 46, and 80 months, suggesting that the accuracy for this approach requires a minimum of three years to elapse from diagnosis to the time an accurate prediction can be made. Conclusion The results of this study suggest that early and accurate prediction of median survival time after AIDS diagnosis may be possible using early quantiles of the survival distribution. The methodology did not seem to work well during a period of significant change in survival as observed with highly active antiretroviral treatment, but results suggest that it may work well in a time of more gradual improvement in survival.
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Longo B, Pezzotti P, Boros S, Urciuoli R, Rezza G. Increasing proportion of late testers among AIDS cases in Italy, 1996–2002. AIDS Care 2007; 17:834-41. [PMID: 16120500 DOI: 10.1080/09540120500038397] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In recent years, the proportion of individuals who are unaware of being infected with HIV when diagnosed with AIDS (defined as 'late testers') has dramatically increased in several European countries, including Italy. We evaluated the extent and determinants of late testing and its impact in terms of AIDS-defining illnesses among AIDS cases reported to the Italian National AIDS Registry since 1996. Late testers were defined as those persons whose first positive HIV test result was within six months of the AIDS diagnosis. Late testers were more likely to be heterosexual contacts or MSWM, as opposed to IDUs. They were also more likely to come from low prevalence areas of Italy or from foreign countries. At AIDS diagnosis, late testers were less likely to be undergoing HAART or prophylaxis against PCP/toxoplasmosis, compared to non-late testers. The mean CD4 cell count at AIDS diagnosis was significantly lower among late testers. PCP, toxoplasmosis and Kaposi's sarcoma were more frequently diagnosed as an AIDS-defining illness in late testers, who also had a significantly higher risk of presenting with multiple concomitant AIDS-defining illnesses. In conclusion, late testing results in missed opportunities for preventing and treating HIV infection, leading to an increased risk of developing preventable opportunistic infections and death.
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Affiliation(s)
- B Longo
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
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Rius C, Binefa G, Montoliu A, Esteve A, Ribas G, Gispert R, Casabona J. Cambio de la supervivencia de los casos de sida en Cataluña (1981-2001). Med Clin (Barc) 2006; 127:167-71. [PMID: 16834951 DOI: 10.1157/13090705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Our goal was to assess survival changes among AIDS patients in Catalonia. PATIENTS AND METHOD We analyzed AIDS cases older than 13 years notified in the Catalonian AIDS Registry from January 1981 to December 2001. Sex, age, transmission category, AIDS-defining disease and diagnostic period were included. The survival cumulative risk was computed for each diagnostic period with Kaplan-Meier methods. RESULTS During the study period 13,485 AIDS cases were reported. Median survival time was 0.9 years for 1981-1987, 1.7 for 1988-1993 and 2.4 years for 1994-August 1996. The survival time of 75% of patients diagnosed in September 1996-1997 and 1998-2001 was 1.57 and 2.02 years, respectively. Multivariate analyses showed a higher risk among intravenous drug users (hazard ratio = 1.25; 95% confidence interval, 1.17-1.33) than in homo/bisexual men. When we compared heterosexual and homo/bisexual groups, we found that the result was not significant (hazard ratio = 0.99; 95% confidence interval, 0.92-1.08). The analysis stratified by AIDS-defining disease showed a decrease in the risk of death in most illnesses. CONCLUSIONS Our results confirm the increase in survival in AIDS cases related to highly active antirretroviral therapy (HAART).
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Affiliation(s)
- Cristina Rius
- Agència de Salut Pública de Barcelona, Barcelona, España
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Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS 2006; 20:561-5. [PMID: 16470120 DOI: 10.1097/01.aids.0000210610.52836.07] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney disease is an increasingly important complication of HIV. OBJECTIVES To examine the incidence and predictors of acute renal failure before and after the introduction of HAART, and the impact of acute renal failure on in-hospital mortality in the post-HAART era. METHODS Adults hospitalized in acute care hospitals in New York State during 1995 (pre-HAART) or 2003 (post-HAART) were identified from the state Planning and Research Cooperative System database. HIV status was defined by primary or secondary diagnosis code. The impact of HIV and HAART on the incidence of acute renal failure and mortality, and the impact of acute renal failure on mortality, was assessed using chi analysis and multivariate regression. RESULTS There were 52,580 HIV-infected patients discharged from hospital in 1995 and 25,114 in 2003. Compared with uninfected patients, HIV-infected patients had an increased incidence of acute renal failure in both the pre-HAART [adjusted odds ratio (OR), 4.62; 95% confidence interval (CI), 4.30-4.95] and post-HAART eras (adjusted OR, 2.82; 95% CI, 2.66-2.99). In the post-HAART cohort, acute renal failure was associated with traditional predictors such as age, diabetes mellitus, and chronic kidney disease, as well as acute or chronic liver failure or hepatitis coinfection (P < 0.001 for all comparisons). Acute renal failure was associated with mortality among HIV-infected patients in the post-HAART era (OR, 5.83; 95% CI, 5.11-6.65). CONCLUSIONS Acute renal failure remains common among hospitalized patients with HIV and is associated with chronic kidney disease, liver disease, and increased mortality.
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Affiliation(s)
- Christina M Wyatt
- Division of Nephrology, Department of Medicine, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
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Merito M, Bonaccorsi A, Pammolli F, Riccaboni M, Baio G, Arici C, Monforte AD, Pezzotti P, Corsini D, Tramarin A, Cauda R, Colangeli V, Pastore G. Economic evaluation of HIV treatments: The I.CO.N.A. cohort study. Health Policy 2005; 74:304-13. [PMID: 16226140 DOI: 10.1016/j.healthpol.2005.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2004] [Accepted: 01/20/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the changes in costs of care for HIV-positive patients in Italy after the spread of antiretroviral combination therapies (HAART). METHODS Five thousand four hundred and twenty-two patients from the I.CO.N.A. (Italian Cohort Naive Antiretrovirals) study were followed between 1997 and 2002. Costs included antiretroviral therapies (ART), hospital admissions, prophylaxis, and main laboratory examinations. The perspective was that of the National Health Service. RESULTS Admission costs per person-year decreased from 2148 euro in 1997 to 256 in 2002, while the average annual costs of ART increased from 2145 to 3149 euro (1997 prices). From 1997 to 1999, ART costs increased from 42.3 to 85.9% of the total, while admission costs decreased from 42.3 to 7.0% and prophylaxis from 7.3 to 1.7%. The breakdown of ART costs shows how dual therapies decreased over time in favor of HAART, falling from 26.8% in 1997 to 5.9% in 2002. Patients with fewer than five treatment switches had the lowest costs distributions over the entire observation period. CONCLUSIONS From 1997 to 2002 inpatient costs progressively decreased in favor of antiretroviral therapy. Annual average costs per patient decreased, while total direct costs increased over time: health resources, initially concentrated on hospitalized patients were then distributed over a growing number of subjects.
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Affiliation(s)
- Monica Merito
- Laboratory of Economics and Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà 33, 56127 Pisa, Italia.
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Iloeje UH, Yuan Y, L'italien G, Mauskopf J, Holmberg SD, Moorman AC, Wood KC, Moore RD. Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients. HIV Med 2005; 6:37-44. [PMID: 15670251 DOI: 10.1111/j.1468-1293.2005.00265.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV-infected patients. METHODS We estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIV-infected patients using a time-dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted. RESULTS Of a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person-years of follow-up (PYFU) in the PI-exposed and nonexposed groups, respectively (P=0.0008). PI exposure >/=60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HR(adj)) 1.71; 95% confidence interval (CI) 1.08-2.74; P=0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HR(adj) 1.90; 95% CI 1.13-3.20; P=0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre-existing CVD. CONCLUSIONS Patients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV-infected patients.
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Affiliation(s)
- U H Iloeje
- Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Wallingford, CT, USA
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Galai N, Vlahov D, Bareta JC, Wang C, Cohn S, Sterling TR. Prognostic Factors for Survival Differ According to CD4+ Cell Count Among HIV-Infected Injection Drug Users. J Acquir Immune Defic Syndr 2005; 38:74-81. [PMID: 15608529 DOI: 10.1097/00126334-200501010-00014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To identify prognostic indicators of survival at different CD4 cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). A community-recruited cohort of injection drug users followed semiannually from 1988 through 2000. Five partially overlapping subcohorts were defined by when participants first reached a CD4 cell level of 351 to 500, 201 to 350, 101 to 200, 51 to 100, or </=50 cells/microL. Prognostic factors were measured at entry into each category. Kaplan-Meier survival estimates for HIV-related death and Cox regression models were constructed by CD4 category. Among the 1030 HIV-infected IDUs, survival improved in the HAART-era with hazard ratios 0.42, 0.36, 0.24, 0.21, and 0.25, respectively, for CD4 cell groups of 500 to 351, 350 to 201, 200 to 101, 100 to 51, and </=50 cells/microL. Shorter survival was associated with prior hospitalization, AIDS, and sexually transmitted disease, with similar effects in the pre-HAART and HAART eras. For the lowest CD4 cell level, prior sepsis or endocarditis, outpatient/emergency room visits, and alcohol use provide additional prognostic value. Survival among HIV-infected IDUs improved since the introduction of HAART, even though utilization of HAART was incomplete. Clinical and behavioral variables provided prognostic information about survival, including substance use indicators.
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Affiliation(s)
- Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Porter K, Babiker A, Bhaskaran K, Darbyshire J, Pezzotti P, Porter K, Walker AS. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet 2003; 362:1267-74. [PMID: 14575971 DOI: 10.1016/s0140-6736(03)14570-9] [Citation(s) in RCA: 260] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) was introduced in 1997. We aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion. METHODS We used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted. Retrospective and prospective data were used. We compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART). FINDINGS Of 7740 seroconverters, 2000 (26%) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 0.47 [95% CI 0.39-0.56] in 1997, dropping further to 0.16 [0.12-0.22] in 2001. Correspondingly, the proportion of person-time on HAART increased from 22% in 1997 to 57% in 2001. By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men (HR 4.28 [2.86-6.41]). However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years (2.03 [1.67-2.47]), in 1999-2001 there was little evidence of a difference in risk by age (HR=1.17 [0.60-2.30]; interaction p=0.06). No such attenuation in the effect of age on survival was observed (p=0.63). INTERPRETATION Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART; however, the importance of age and exposure category as determinants of progression seems to have changed.
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Affiliation(s)
- Kholoud Porter
- Clinical Trials Unit, 222 Euston Road, , London NW1 2DA, UK.
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Dray-Spira R, Lert F. Social health inequalities during the course of chronic HIV disease in the era of highly active antiretroviral therapy. AIDS 2003; 17:283-90. [PMID: 12556681 DOI: 10.1097/00002030-200302140-00001] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hamers FF, Infuso A, Alix J, Downs AM. Current situation and regional perspective on HIV/AIDS surveillance in europe. J Acquir Immune Defic Syndr 2003; 32 Suppl 1:S39-48. [PMID: 12571514 DOI: 10.1097/00126334-200302011-00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIDS reporting has been the principal means of monitoring the HIV/AIDS situation in Europe since 1984 [corrected]. HIV reporting was set up at the European level in 1999, although it has existed in most European countries since the 1980s. Anonymous individual data on AIDS and, if available, new HIV diagnoses, and data on HIV prevalence in various populations are reported from the 51 countries of the WHO European Region to EuroHIV, and aggregate data on HIV prevalence in various populations [corrected]. Data are presented after grouping the 51 countries into three geographic areas: the West, Center, and East. At end of 2000, in the West, AIDS incidence continued to decline except among those infected heterosexually; numbers of newly diagnosed HIV infections are relatively stable, but rising among heterosexually infected persons, many of whom originate from countries with generalized HIV epidemics. In the East, numbers of newly diagnosed HIV cases (mostly injection drug users) continue to rise steeply, particularly in the Russian Federation, Latvia, and Estonia. In the Center, levels of HIV and AIDS remain low. HIV reporting is becoming a central element of HIV/AIDS surveillance in Europe. Heterogeneity between countries in health care systems, HIV testing patterns and surveillance systems remain challenging for data standardization at the European level. Efforts should be made to use surveillance data for evaluating the effectiveness of HIV/AIDS prevention interventions.
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Affiliation(s)
- Françoise F Hamers
- EuroHIV, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint-Maurice, France.
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Dore GJ, Li Y, McDonald A, Ree H, Kaldor JM, Kaldo JM. Impact of highly active antiretroviral therapy on individual AIDS-defining illness incidence and survival in Australia. J Acquir Immune Defic Syndr 2002; 29:388-95. [PMID: 11917244 DOI: 10.1097/00126334-200204010-00010] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of highly active antiretroviral therapy (HAART) on incidence of initial AIDS-defining illnesses (ADIs) and survival after individual ADIs. METHODS Australian AIDS notification data over the period 1993 to 2000 were examined. Analyses were based on all initial ADIs. To examine the impact of HAART, two periods of AIDS diagnosis were chosen: pre-HAART (1993-1995) and HAART (1996-2000). Comparisons between these two periods included proportion of individual ADIs, median CD4 lymphocyte counts at and survival following AIDS and individual ADIs. Median survival was based on Kaplan-Meier estimates, with examination of factors influencing survival in a Cox proportional hazards model. RESULTS Over the period 1993 to 2000 in Australia, 5017 initial ADIs were diagnosed among 4351 AIDS cases. At AIDS diagnosis, changes from the pre-HAART (1993-1995) to HAART (1996-2000) periods included an increased proportion of Pneumocystis carinii pneumonia (PCP) (25.9% to 30.4%; p =.001), AIDS dementia complex (5.2% to 6.8%; p = 0.029), non-Hodgkin lymphoma (NHL) (4.4% to 6.3%; p =.005), and tuberculosis (0.5% to 2.7%; p <.0005). Median survival following AIDS increased from 19.6 months for AIDS cases diagnosed in 1993 to 1995 to 39.6 months for AIDS cases diagnosed in 1996 to 2000 (p <.0005). Median survival was stable for NHL (7.5-8.8 months; p =.26), but increased significantly for almost all other ADIs. CONCLUSIONS An increased proportion of PCP relative to other ADIs suggests an increasing proportion of AIDS patients not receiving specific prophylaxis, presumably because of "late" HIV diagnosis. Survival following almost all ADIs has increased in the era of HAART, although the prognosis after NHL remains extremely poor.
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Affiliation(s)
- Gregory J Dore
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
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Gange SJ, Barrón Y, Greenblatt RM, Anastos K, Minkoff H, Young M, Kovacs A, Cohen M, Meyer WA, Muñoz A. Effectiveness of highly active antiretroviral therapy among HIV-1 infected women. J Epidemiol Community Health 2002; 56:153-9. [PMID: 11812817 PMCID: PMC1732079 DOI: 10.1136/jech.56.2.153] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To describe the impact of highly active antiretroviral therapy (HAART) on mortality, morbidity, and markers of HIV disease progression in HIV infected women. DESIGN Data collected from the Women's Interagency HIV Study, a prospective cohort study that enrolled women between October 1994 and November 1995. SETTING Six clinical consortia based in five cities in the United States (New York, NY; Washington, DC; Los Angeles, CA; San Francisco, CA; and Chicago, IL). PARTICIPANTS A total of 1691 HIV seropositive women with a study visit after April 1996. MAIN RESULTS Beginning in April 1996, the self reported use of HAART increased over time, with more than 50% of the cohort reporting HAART use in 1999. There was a 23% decline per semester in the incidence of AIDS from April 1996 (95% confidence intervals (CI) -29% to -16%). Furthermore, there was a 21% decline of the semiannual mortality rates among those with AIDS at baseline (95% CI -27% to -14%) and an 11% decline among those AIDS free at baseline (95% CI -3% to -18%). CD4+ lymphocyte counts either increased (women with baseline AIDS) or stabilised (women without baseline AIDS) after April 1996, and HIV RNA levels dramatically declined in both groups, although the percentage of women with HIV RNA above 4000 cps/ml remained stable at approximately 40% since mid-1997. CONCLUSIONS Despite concerns regarding the use of antiretroviral therapies in this population, the use of therapies led to improved immunological function, suppressed HIV disease activity, and dramatic declines in morbidity and mortality.
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Affiliation(s)
- S J Gange
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
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Poundstone KE, Chaisson RE, Moore RD. Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy. AIDS 2001; 15:1115-23. [PMID: 11416713 DOI: 10.1097/00002030-200106150-00006] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The advent of highly active antiretroviral therapy (HAART) has reduced the incidence of most AIDS-related opportunistic illnesses (OI) and death in HIV-infected individuals. We investigated whether there are demographic disparities in HIV disease progression in the HAART era compared with before. METHODS HIV-infected patients in an urban HIV clinical practice in the USA were compared using survival methods for time to a new AIDS-defining OI or death in therapeutic era 1 (monotherapy and combination therapy; 1990--1995; n = 2016) versus era 2 (HAART; 1996--1999; n = 2165). RESULTS A total of 1037 (51.4%) events occurred in era 1; 666 (30.8%) events occurred in era 2. In women, the median disease-free survival time increased by 14% (CD4 cell counts > 200 cells/mm(3) at baseline) and 34% (CD4 cell counts < or = 200) in era 2 compared with era 1, whereas for men it increased by 43 and 100%. The relative hazard (RH) of progression for women compared with men in era 2 compared with era 1 was 1.34. For injecting drug use (IDU), disease-free survival time increased by 16% and 34% in era 2 compared with era 1, whereas non-IDU improved by 65 and 135%. The RH of progression for IDU compared with non-IDU in era 2 compared with era 1 was 1.39. No significant differences were detected by race or other HIV transmission risk group. CONCLUSION Disease-free survival time was extended with the use of HAART, but these gains were not equally distributed by sex and IDU in our cohort.
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Affiliation(s)
- K E Poundstone
- Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA
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Porta D, Forastiere F, Rapiti E, Perucci CA. Temporal changes of progression to AIDS in the era of highly active antiretroviral therapy: Lazio Region, Italy, 1988 to June 2000. J Acquir Immune Defic Syndr 2001; 27:93-5. [PMID: 11404527 DOI: 10.1097/00126334-200105010-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Temporal Changes of Progression to AIDS in the Era of Highly Active Antiretroviral Therapy: Lazio Region, Italy, 1988 to June 2000. J Acquir Immune Defic Syndr 2001. [DOI: 10.1097/00042560-200105010-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Conti S, Masocco M, Pezzotti P, Toccaceli V, Vichi M, Boros S, Urciuoli R, Valdarchi C, Rezza G. Differential impact of combined antiretroviral therapy on the survival of italian patients with specific AIDS-defining illnesses. J Acquir Immune Defic Syndr 2000; 25:451-8. [PMID: 11141245 DOI: 10.1097/00042560-200012150-00011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A decrease in HIV-related mortality and morbidity has been observed since 1996 in most developed countries as a consequence of the extensive use of combined antiretroviral therapies. The purpose of this study was to investigate whether combined antiretroviral therapies had a differential impact on the survival of patients with different AIDS-defining illnesses (ADIs). METHODS In total, 35,318 persons representing all the adults with AIDS (PWAs) diagnosed in Italy from January 1, 1990 to August 31, 1998 were studied. Actuarial life tables and the Kaplan-Meier method were used to estimate the cumulative probability of survival; the multivariate Cox proportional hazards model was used to estimate adjusted relative hazard of death (RH). RESULTS Among PWAs diagnosed after 1995, the proportion of survivors 24 months after diagnosis was more than doubled (66%) compared with that of PWAs diagnosed before the end of 1995 (31%). Significantly decreased RHs for some ADIs were observed as early as 1996 (i.e., esophageal candidiasis, Pneumocystis carinii pneumonia, brain toxoplasmosis, HIV-wasting syndrome, and pulmonary tuberculosis). In the last period (1997-1998), the decrease was marked and significant for almost all the ADIs, ranging from 55% to 80% compared with the RHs of the reference year (1995). Conversely, primary lymphoma of the brain and Burkitt's lymphoma showed a low and not statistically significant decrease; these were the ADIs with the worst outcome. CONCLUSIONS After 1995, there was a rather uniform increase in the survival of PWAs diagnosed with most specific ADIs but not for patients affected by primary brain lymphoma and Burkitt's lymphoma. The determinants of this differential effect need to be investigated.
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Affiliation(s)
- S Conti
- Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy.
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Sabin CA. The role of observational studies in assessing the impact of antiviral therapies. Curr Opin Infect Dis 2000; 13:631-635. [PMID: 11964833 DOI: 10.1097/00001432-200012000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the past year many observational studies have reported on the impact of highly active antiretroviral therapy on their patient populations. Care should be taken when interpreting these findings because of possible biases due to reporting delay and loss to follow-up. The results are very encouraging, however, suggesting dramatic reductions in the incidence of AIDS and death, and resulting hospitalizations.
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Affiliation(s)
- Caroline A. Sabin
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
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Differential Impact of Combined Antiretroviral Therapy on the Survival of Italian Patients With Specific AIDS-Defining Illnesses. J Acquir Immune Defic Syndr 2000. [DOI: 10.1097/00126334-200012150-00011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li Y, McDonald AM, Dore GJ, Kaldor JM. Improving survival following AIDS in Australia, 1991-1996. National HIV Surveillance Committee. AIDS 2000; 14:2349-54. [PMID: 11089623 DOI: 10.1097/00002030-200010200-00016] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the pattern of survival following AIDS. DESIGN National surveillance for AIDS diagnoses. METHODS AIDS cases in adults/adolescents (aged 13 years or older at AIDS diagnosis) and deaths following AIDS were notified to the national HIV surveillance centre by the diagnosing doctor through State/Territory health authorities. The date of last medical contact for each case living with AIDS was updated annually. RESULTS By 30 June 1999, 4814 AIDS cases, diagnosed in Australia in 1991-1996, and 3193 deaths following AIDS had been notified to the National AIDS Registry. Median survival following AIDS was 17.7 months. Survival following AIDS increased from 16.0 months in 1991 to 27.7 months in 1996. Factors independently associated with improved survival were year of AIDS diagnosis, late HIV diagnosis, CD4+ cell count greater than 50 x 10(6) cells/l, age of less than 45 years and presentation with Pneumocystis carinii pneumonia only or Kaposi's sarcoma only. The risk of death declined over time when the initial AIDS-defining illness was Pneumocystis carinii pneumonia only [adjusted hazard ratio (AHR) = 0.91, P < 0.0005]; other opportunistic infections (AHR, 0.88; P < 0.0005); Kaposi's sarcoma only (AHR, 0.92; P = 0.025); and central nervous system conditions (HIV encephalopathy, cryptococcosis, toxoplasmosis) (AHR, 0.92; P = 0.012). No time trend was observed for survival following diagnoses of non-Hodgkin's lymphoma or other multiple illnesses. CONCLUSIONS Survival following AIDS has improved in Australia, especially among cases diagnosed in 1995 and 1996. Temporal improvements in survival following AIDS were coincident with the introduction of combination antiretroviral treatment for HIV infection and suggest that treatment is effective in limiting disease progression among people with advanced HIV infection.
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Affiliation(s)
- Y Li
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Darlinghurst, Australia
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Rapiti E, Porta D, Forastiere F, Fusco D, Perucci CA. Socioeconomic status and survival of persons with AIDS before and after the introduction of highly active antiretroviral therapy. Lazio AIDS Surveillance Collaborative Group. Epidemiology 2000; 11:496-501. [PMID: 10955400 DOI: 10.1097/00001648-200009000-00003] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We estimated the AIDS survival by neighborhood socioeconomic status before (1993-1995) and after (1996-1997) the introduction of highly active antiretroviral therapy in Rome, Italy, in a retrospective cohort of persons with AIDS followed through July 31, 1998. Participants included 1,474 persons with AIDS residing in Rome who were diagnosed in 1993-1997. We calculated hazard ratios (HRs) of death for two diagnostic periods (before and after highly active antiretroviral therapy was introduced) by neighborhood socioeconomic status categorized into four levels (level I = highest socioeconomic status), using the Cox model and adjusting for gender, age, intravenous drug use, CD4 cell count at diagnosis, AIDS-defining disease, and hospital of diagnosis. Thirty-four per cent of persons with AIDS (N = 503) had survived as of mid-1998. For persons with AIDS diagnosed in 1993-1995, we found little difference in the risk of death by neighborhood socioeconomic status. For 1996-1997, the risk of death was greater for persons with lower neighborhood socioeconomic status, especially for levels III and IV [HR = 2.81 (95% confidence interval = 1.38-5.76), and HR = 2.55 (95% confidence interval = 1.27-5.14), respectively, compared with level I]. Stratified analyses showed that the greatest difference was found for women and drug users. In conclusion, even in a country with universal health coverage that provides therapy at no cost, differences in survival of persons with AIDS have emerged by neighborhood socioeconomic status since highly active antiretroviral therapy was introduced. Inequalities in health-care access or in medical management, or poor adherence to treatment, could explain the observed heterogeneity.
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Affiliation(s)
- E Rapiti
- Department of Epidemiology, Lazio Region Health Authority, Rome, Italy
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Castilla J, de la Fuente L. [Trends in the number of human immunodeficiency virus infected persons and AIDS cases in Spain: 1980-1998]. Med Clin (Barc) 2000; 115:85-9. [PMID: 10965481 DOI: 10.1016/s0025-7753(00)71473-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To describe the trend in the number of HIV-infected persons and the number of AIDS cases in Spain between 1980 and 1998. SUBJECTS AND METHODS The following information was used: annual incidence of AIDS taken from the National Registry, AIDS deaths taken from the same registry and from the Registry of Vital Statistics, HIV seroprevalence in studies in sentinel populations, HIV incidence in cohorts of exposed persons, and reports of HIV infections in the registries existing in the autonomous communities. We considered three events of interest--HIV infection, AIDS and death--which were related using back-projection and compartmental models. RESULTS HIV spread rapidly in Spain during the years 1980. Transmission subsequently declined by more than 50% to figures that probably do not exceed 6,000 new infections in 1998. The incidence of AIDS increased to more than 7,000 new cases in 1994 and has since declined to some 4,000 cases in 1998. The level of AIDS mortality has always been lower than the incidence; it increased up to 1995 and then dropped to less than half in subsequent years. The number of living persons infected with HIV, including AIDS cases, arose until the early years 1990 and has since remained steady at about 125,000 persons. The number of cases of living persons with AIDS has increased continuously, and is estimated at about 19,000 through the end of 1998. CONCLUSIONS The recent trend in new infections, AIDS cases and deaths is favourable, while the number of infected living persons remains very high.
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Affiliation(s)
- J Castilla
- Centro Nacional de Epidemiologá, Instituto de Salud Carlos III, Secretaría del Plan Nacional sobre Sida, Madrid.
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