title: Effect of highly active antiretroviral therapy on multiple AIDS-defining illnesses among male HIV seroconverters.
abstract: The effect of highly active antiretroviral therapy (HAART) on multiple acquired immunodeficiency syndrome (AIDS)-defining illnesses remains unclear. Between 1984 and 2005, 573 male human immunodeficiency virus seroconverters in four US urban centers were followed for a median of 9.7 years. During follow-up, 345, 113, 50, and 65 men incurred 0, 1, 2, and >2 AIDS-defining illnesses, respectively. The authors extend the Cox proportional hazards model to determine whether the effect of HAART, as measured by calendar periods, persists beyond the first AIDS-defining illness. After adjustment for race and age at seroconversion, the hazards of a first through third AIDS-defining illness in the HAART calendar period (beyond July 1995) were 0.31 (95% confidence interval (CI): 0.21, 0.46), 0.39 (95% CI: 0.22, 0.74), and 0.33 (95% CI: 0.14, 0.79), respectively, relative to the monotherapy and combination therapy reference calendar period (January 1990-July 1995) and therefore did not attenuate with the number of prior AIDS-defining illnesses (p for homogeneity = 0.83). After the authors averaged over multiple AIDS-defining illnesses, the hazard of an AIDS-defining illness in the HAART calendar period was 0.34 (95% CI: 0.25, 0.45) relative to the reference calendar period. HAART protects against initial and subsequent AIDS-defining illnesses, whose inclusion in analysis markedly increased the precision of the estimated hazard ratio.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street E7640, Baltimore, MD 21205, USA. lcain@jhsph.edu
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cain
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Margolick
authors.forename: Charles R
authors.initials: CR
authors.lastname: Rinaldo
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006679:HIV Seropositivity / Q000097:blood*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology