AEGiS-13IAC: Trends in AIDS survival in San Francisco: Does treatment continue to be effective?

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Trends in AIDS survival in San Francisco: Does treatment continue to be effective?

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC722)

Schwarcz S, Hsu LC, Vittinghoff E, Katz M, McFarland W
S. Schwarcz, 25 Van Ness, Suite 500, San Francisco, CA 94102, United States, Tel.: +1 415 554 9134, Fax: +1 415 431 0353, E-mail: Sandy_Schwarcz@dph.sf.ca.us

BACKGROUND: Declines in AIDS deaths in the United States were first observed in 1996 and attributed in part to use of protease inhibitors (PI) and other antiretroviral therapies (ART). In 1997, the rate of decline of AIDS deaths slowed, suggesting that the effect of treatment may have waned. San Francisco (SF) was one of the earliest AIDS epidemic centers in North America, has a highly treated HIV-infected population, and has highly complete AIDS surveillance data that includes detailed follow-up information on treatment and treatment outcomes. We used SF AIDS surveillance data to evaluate temporal trends in AIDS survival between 1995 and 1997 and to assess the impact of treatment on survival after AIDS.

METHODS: The Kaplan Meier Product Limit test was used to assess temporal trends in AIDS survival among 2567 persons diagnosed between 1995 and 1997 with one of the opportunistic illnesses included in the 1987 AIDS case definition. The Cox Proportional Hazards model was used to calculate predictors of survival among 3191 persons who were diagnosed between 1995 and 1997 and met the 1993 AIDS case definition.

RESULTS: Median survival was 23 months for persons diagnosed in 1995, 45 months for persons diagnosed in 1996, and could not be determined for persons diagnosed in 1997. The proportion of persons surviving two years after diagnosis was 50% for persons diagnosed in 1995, 68% for persons diagnosed in 1996, and 70% for persons diagnosed in 1997. Decreased mortality was associated with use of ART without PI before AIDS (relative hazard (RH) 0.65, 95% confidence limits (CL) 0.50-0.84) and after AIDS (RH, 0.63, 95% CL 0.49-0.82), and use of ART with PI before AIDS (RH 0.45, 95% CL 0.32-0.62), and after AIDS (RH 0.44, 95% CL 0.34-0.57).

CONCLUSIONS: Survival after AIDS has continued to increase for persons diagnosed in recent years. ART, particularly when combined with PI is effective and strongly predicts improved survival.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Proportional Hazards Models, HIV Infections, CD4 Lymphocyte Count, Survival Analysis, Survival, Survival Rate, Antiretroviral Therapy, Highly Active, Drug Therapy, Combination, Prognosis, Protease Inhibitors, United States, San Francisco, North America, therapy, trends, mortality, Diagnosis, drug therapy
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ThOrC722