HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.
BACKGROUND
Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis.


METHODS
We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression.


RESULTS
The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51).


CONCLUSIONS
Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.
May
Margaret T
MT
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. m.t.may@bristol.ac.uk
Sterne
Jonathan A C
JA
Costagliola
Dominique
D
Sabin
Caroline A
CA
Phillips
Andrew N
AN
Justice
Amy C
AC
Dabis
François
F
Gill
John
J
Lundgren
Jens
J
Hogg
Robert S
RS
de Wolf
Frank
F
Fätkenheuer
Gerd
G
Staszewski
Schlomo
S
d'Arminio Monforte
Antonella
A
Egger
Matthias
M
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000635:transmission; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D009656:North America; D011379:Prognosis; D012309:Risk-Taking; D013997:Time Factors