Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy.
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.
Poundstone
K E
KE
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA.
Chaisson
R E
RE
Moore
R D
RD
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