Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis. Adult/Adolescent Spectrum of Disease Group.
OBJECTIVE
To examine the effects of antiretroviral therapy (ART) and opportunistic illness chemoprophylaxis on the survival of persons with AIDS and survival time based on year of AIDS diagnosis.


METHODS
Longitudinal medical record review.


METHODS
Ninety-three hospitals and clinics in nine cities in the USA.


METHODS
We observed 19,565 persons with AIDS from 1990 through January 1998.


METHODS
Prescribed use of antiretroviral monotherapy, dual- and triple-combination therapies, primary prophylaxis against Pneumocystis carinii pneumonia and Mycobacterium avium complex, and pneumococcal vaccine.


METHODS
Time from AIDS diagnosis to death in the presence and absence of ART. Survival curves were compared of AIDS cases diagnosed during 1990-1992 and 1993-1995.


RESULTS
Triple ART had the greatest effect on the risk of death [relative risk (RR), 0.15; 95% confidence limit (CL), 0.12, 0.17], followed by dual ART (RR, 0.24; 95% CL, 0.22, 0.26), and monotherapy (RR, 0.38; 95% CL, 0.36, 0.40). Risk of death was decreased among persons receiving Pneumocystis carinii pneumonia prophylaxis (RR, 0.79; 95% CL, 0.70, 0.89) and Mycobacterium avium complex prophylaxis (RR, 0.76; 95% CL, 0.68, 0.86). Median survival increased from 31 months [95% confidence interval (CI), 30-32 months] for AIDS cases diagnosed during 1990-1992 to 35 months (95% CI, 35-38 months) for cases diagnosed during 1993-1995.


CONCLUSIONS
The risk of death was decreased for persons receiving triple ART compared with persons receiving dual therapy and persons receiving monotherapy. Increased use of ART and improved ART regimens probably contributed to prolonged survival of persons whose diagnosis was made during 1993-1995 compared with persons whose diagnosis was made during 1990-1992.
McNaghten
A D
AD
Council of State and Territorial Epidemiologists, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Hanson
D L
DL
Jones
J L
JL
Dworkin
M S
MS
Ward
J W
JW
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001428:Bacterial Vaccines / Q000008:administration & dosage; D018890:Chemoprevention; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000517:prevention & control; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology; D015996:Survival Rate
D019380:Anti-HIV Agents; D001428:Bacterial Vaccines