Dramatic changes in survival and death rates after AIDS through the evolution of antiretroviral therapy, Paris
Abstract number: p619
Couzigou C., Semaille C., Pinget R., Le Strat Y., Pillonel J., Lot F., Cazein F., Vittecoq D., Desenclos J.C.
We explored changes in the survival of persons with AIDS (PWA) according to the availability of antiretroviral drugs from 1994 to 2002. We tested whether changes in the hazard ratio (HR) of progression to death have been homogeneous among various groups of PWA.
This study included PWA diagnosed in Paris in 19942001, reported to the National Institute for Public Health Surveillance by 2002 and followed for vital status up to October 2002.
No individual information on treatments was available through AIDS case reporting. Data on antiretroviral drugs prescribed in Paris among PWA were obtained from the French Hospital Database on HIV. According to these data, calendar period was divided into 4 periods: monotherapy (19941995), transition dual therapy-HAART (1996), early HAART (19971999), late HAART (2000October 2002).
A Cox regression in which calendar period was modelled as a time-dependent covariate, was used. HR of progression to death during a given period was compared with the calendar period of reference (monotherapy) adjusting for confounding variables. Cox regressions stratified by age, transmission category, CD4 cell count, and initial AIDS defining illness (es) (ADIs) were used.
4158 PWA contributed 7690 years at risk. The mortality rate (per 100 patients years) declined from 57.9 (monotherapy), to 38.8 (transition dual therapy-HAART), 23.7 (early HAART) and 7.1 (late HAART period). Adjusted HR of progression to death reached a minimum in the late HAART period (HR 0.22, 95% CI: 0.190.26). No difference in the decrease of the HR of progression to death has been found by age. HR decreased and was marked during the late HAART period across all HIV transmission categories, including intravenous drug users (0.23, 0.150.35). Among PWA diagnosed with tuberculosis, the HR decreased significantly only in the late HAART period (0.34, 0.190.63), while it decreased earlier and stronger for all other ADIs, also for progressive multifocal leucoencephalopathy, HIV dementia and tumours. Since HAART introduction the decrease of HR was stronger for PWA with a CD4 cell count <=200/mm3 compared with those with a CD4 cell count >200/mm3.
Survival has continued to increase since the Introduction: of HAART but was however heterogeneous according CD4 cell count at AIDS diagnosis and ADIs. Our study suggests that cardiovascular diseases and the risk of emergence of HIV resistance has not affected mortality until 2002 in PWA.
|Session name:||XXIst ISTH Congress|
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