title: Mortality and progression to AIDS after starting highly active antiretroviral therapy.
abstract: OBJECTIVE
  To examine survival and progression to AIDS among HIV-infected patients after starting highly active antiretroviral therapy (HAART).
  
  
  METHODS
  The study population consisted of 3724 patients from the ATHENA observational cohort who initiated HAART. We considered progression to either an AIDS-defining disease or death, distinguishing HIV-related and non-related (including therapy-related) deaths. A time-dependent multivariate hazards model was fitted to the patient data and 5-year survival probabilities under various therapy scenarios estimated.
  
  
  RESULTS
  A total of 459 patients developed AIDS and 346 died during 12 503 person-years of follow-up. HIV-related mortality decreased from 3.8 to 0.7 per 100 person-years between 1996 and 2000 whereas non-HIV-related mortality did not change (0.4 and 0.9, respectively, P = 0.25). For asymptomatic and symptomatic therapy naive patients younger than 50 years with CD4 counts above 10 x 10(6) and 150 x 10(6) cells/l, respectively, predicted 5-year survival probabilities were above 90% when HAART was used continuously. This limit was 450 x 10(6) cells/l when HAART was used during 20 weeks in each 24 week-period of follow-up, and 110 x 10(6) cells/l when patients delayed initiation of HAART for 1 year after becoming eligible for treatment.
  
  
  CONCLUSIONS
  Survival probabilities were high among HIV-infected patients initiating HAART at an early stage of infection. The best therapy strategy is therefore to start HAART at this stage of infection. However, deferring HAART in patients with high CD4 cell counts may be clinically more appropriate given toxicity and adherence problems. The lack of any change in non-HIV-related mortality suggests that toxicity has not yet become a major risk factor for death.
authors.affiliation: HIV Monitoring Foundation, Academic Medical Centre of the University of Amsterdam, Amsterdam, The Netherlands. A.I.vanSighem@amc.uva.nl
authors.forename: Ard I
authors.initials: AI
authors.lastname: van Sighem
authors.forename: Mark A
authors.initials: MA
authors.lastname: van de Wiel
authors.forename: Azra C
authors.initials: AC
authors.lastname: Ghani
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Jambroes
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Inge C
authors.initials: IC
authors.lastname: Gyssens
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.forename: Joep M A
authors.initials: JM
authors.lastname: Lange
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality / Q000635:transmission; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count / Q000379:methods; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D011446:Prospective Studies