[Effect of highly active antiretroviral therapy on the clinical onset of AIDS defined by clinical episodes].
BACKGROUND
The frequency of opportunistic infections and the mortality of HIV-infected patients have changed notably since the widespread use of highly active antiretroviral therapy. Accordingly, the spectrum of first AIDS-defining conditions may have changed too. The aim of the present study was to analyze whether there have been changes in the clinical presentation of AIDS after the extensive use of highly active antiretroviral therapy.


METHODS
We performed an analysis of the presentation forms of AIDS in 190 patients with a prospective follow-up who developed this disease between April 1989 and December 2000. We compared the first AIDS-defining conditions occurring until December 1996 with those occurring after January 1997.


RESULTS
Visceral leishmaniasis was the first AIDS-defining condition in 18 patients (14.2%) during the first period, whereas it was the AIDS-onset disease in two cases (3.1%) during the second period (P = 0.01). Tuberculosis was the first diagnosis in 63 patients (50%) in the first period and in 26 cases (40.6%) in the second period (P = 0.22). The frequency of other first AIDS-defining disorders remained unchanged along the whole study time.


CONCLUSIONS
With regard to the clinical onset of AIDS, there has been a significant reduction in the frequency of visceral leishmaniasis as the first AIDS-defining disorder after the introduction of highly active antiretroviral therapy. Tuberculosis continues to be the more frequent clinical debut condition of AIDS.
Fernández-Rivera
Javier
J
Servicio de Medicina Interna, Hospital Universitario de Valme, Sevilla, Spain.
Macías
Juan
J
García-García
José Angel
JA
Ramos
Antonio Javier
AJ
Leal
Manuel
M
Pineda
Juan Antonio
JA
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis*