title: Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA.
authors: K E
authors: KE
authors: Poundstone
authors: R E
authors: RE
authors: Chaisson
authors: R D
authors: RD
authors: Moore
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D015497:HIV-1; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D015819:Substance Abuse, Intravenous; D014481:United States