title: Long-term survival and serious cardiovascular events in HIV-infected patients treated with highly active antiretroviral therapy.
abstract: There is continuing interest in the longer term effects of highly active antiretroviral therapy (HAART) on the risk of cardiopulmonary events. We assessed this using updated administrative data from an open retrospective cohort of HIV-infected persons receiving care from the US Veterans Affairs (VA). Information on 41,213 HIV-infected patients receiving VA care between January 1993 and December 2003 was included. Patients were followed for an average of 4 years or 168,213 person-years of follow-up. The death rate fell from 20.9 deaths per 100 patient-years of observation in 1995 to 5.2 deaths per 100 patient-years in 2003. In patient-level analysis, adjusted hazard ratios for death dropped precipitously for all races to a low of 0.18 (95% confidence interval: 0.15 to 0.23) at 72 months of exposure to HAART. Hazards for serious cardiovascular events remained near 1.0 for exposure to HAART, and hazards for serious cardiovascular events, stroke, or death were only slightly higher than for death alone. No selection effects or secular trends were found. The benefits of HAART continued to increase in the 8 years after introduction and with 6 years of individual use. The risk of serious cardiovascular events should be factored into individual patient management but does not pose an important public health risk.
authors.affiliation: Veterans Medical Research Foundation, Veterans Affairs Quality Enhancement Research Initiative for HIV at the Veterans Affairs San Diego Health Care System, San Diego, CA, USA. bozzette@rand.org
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Ake
authors.forename: Henry K
authors.initials: HK
authors.lastname: Tam
authors.forename: Alba
authors.initials: A
authors.lastname: Phippard
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Scharfstein
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Louis
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents