title: Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy.
abstract: OBJECTIVE
  To analyse the impact of combined antiretroviral treatment (cART) on survival with AIDS, according to the nature of the first AIDS-defining clinical illness (ADI); to examine trends in AIDS-defining causes (ADC) and non-AIDS-defining causes (non-ADC) of death.
  
  
  METHODS
  From the French Hospital Database on HIV, we studied trends in the nature of the first ADI and subsequent survival in France during three calendar periods: the pre-cART period (1993-1995; 8027 patients), the early cART period (1998-2000; 3504 patients) and the late cART period (2001-2003; 2936 patients).
  
  
  RESULTS
  The three most frequent initial ADIs were Pneumocystis carinii (jirovecii) pneumonia (PCP) (15.6%), oesophageal candidiasis (14.3%) and Kaposi's sarcoma (13.9%) in the pre-cART period. In the late cART period, the most frequent ADIs were tuberculosis (22.7%), PCP (19.1%) and oesophageal candidiasis (16.2%). The risk of death after a first ADI fell significantly after the arrival of cART. Lower declines were observed for progressive multifocal leukoencephalopathy, lymphoma and Mycobacterium avium complex infection. After an ADI, the 3-year risk of death from an ADC fell fivefold between the pre-cART and late cART periods (39%vs. 8%), and fell twofold for non-ADCs (17%vs. 9%).
  
  
  CONCLUSIONS
  The relative frequencies of initial ADI have changed since the advent of cART. Tuberculosis is now the most frequent initial ADI in France; this is probably the result of the increasing proportion of migrants from sub-Saharan Africa. After a first ADI, cART has a major impact on ADCs and a smaller impact on deaths from other causes. The risk of death from AIDS and from other causes is now similar.
authors: Department of Public Health, Cochin Hospital, Paris, France. sophie.grabar@univ-paris5.fr
authors: S
authors: S
authors: Grabar
authors: E
authors: E
authors: Lanoy
authors: C
authors: C
authors: Allavena
authors: M
authors: M
authors: Mary-Krause
authors: M
authors: M
authors: Bentata
authors: P
authors: P
authors: Fischer
authors: A
authors: A
authors: Mahamat
authors: C
authors: C
authors: Rabaud
authors: D
authors: D
authors: Costagliola
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents