title: Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012.
abstract: OBJECTIVE
  To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI.
  
  
  METHODS
  We used HIV surveillance data to conduct a survival analysis.
  
  
  METHODS
  We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012.
  
  
  RESULTS
  Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17).
  
  
  CONCLUSIONS
  Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.
authors.affiliation: Division of HIV/AIDS Prevention Epidemic Intelligence Service Program.
authors.forename: Kpandja
authors.initials: K
authors.lastname: Djawe
authors.affiliation: Division of HIV/AIDS Prevention.
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.affiliation: HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health.
authors.forename: Ling
authors.initials: L
authors.lastname: Hsu
authors.affiliation: HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health.
authors.forename: Miao-Jung
authors.initials: MJ
authors.lastname: Chen
authors.affiliation: Division of HIV/AIDS Prevention.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Selik
authors.affiliation: Division of HIV/AIDS Prevention.
authors.forename: Charles
authors.initials: C
authors.lastname: Rose
authors.affiliation: Division of HIV/AIDS Prevention ICF International, Assigned Full-time to Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Williams
authors.affiliation: Division of HIV/AIDS Prevention.
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.affiliation: HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health Department of Epidemiology and Biostatistics, University of California San Francisco.
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwarcz
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012514:Sarcoma, Kaposi / Q000150:complications / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult
keywords: AIDS; AIDS-defining illness; HIV; mortality; survival