AEGiS-13IAC: Continued low morbidity and mortality among patients with advanced HIV infection and their patterns of highly active antiretroviral therapy (HAART) usage.

13th International AIDS Conference

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

Continued low morbidity and mortality among patients with advanced HIV infection and their patterns of highly active antiretroviral therapy (HAART) usage.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC723)

Holmberg S, Palella F, Moorman A, Chmiel J, Chan C, Investigators H
S. Holmberg, MSE - 45 CDC, 1600 Clifton Road, Atlanta GA 30333, United States, Tel.: +404 639 61 54, Fax: +404 639 61 27, E-mail: sdh1@cdc.gov

Objectives and

METHODS: To evaluate recent trends in HIV morbidity and mortality we analyzed data from visits of 5006 patients to 8 private and 2 public HIV clinics (the HIV Outpatient Study [HOPS]) from 1/94 to 9/99. We calculated death and opportunistic infection (OI) rates among 1607 patients with a CD4+ cell count > 100 cells/m l. Means of the log plasma HIV RNA (viral load [VL]/ml) over time and most recent CD4+ cell counts were compared among patients taking different antiretroviral regimens.

RESULTS: In 1607 patients followed an average of 19.8 months, death rates fell from a maximum of 30.2/100 person-years (py) in 2nd quarter (Q) 1994 to 8.1/100 py in 2nd Q 1999 and 2.1/100 py in 3rd Q 1999 thus far. The largest declines were seen during 1996 (to 15.3/100 py) and 1997 (to 11.3/100 py) with some further decline in 1998 (to 8.9/100 py) and 1999 (6.4/100 py thus far). Quarterly incidence of AIDS OI's also decreased from an average of 46.9/100 py in 1995 to 6.1/100 py for 1999, again most dramatically in 1996 and 1997. Group mean log VL ranged from 4.79 for those on no therapy to 3.80 for those receiving a protease inhibitor (p > .0001 for linear trend), with an increase in the mean most recent CD4_ cells with increasingly intensive therapy (p > .0001). HAART usage rates rose among all patients analyzed from 3.6% in 4Q95 to 88% by 2ndQ99 and 87% in 3Q99, with over 90% of regimens including at least one PI. Of 1st HAART regimens (n-1022) for patients with CD4 > 500: 68.9% included a single PI with 2 nucleoside analog reverse transcriptase inhibitors (NARTI's); 13.1% had dual PI's; 16.4% had >3 drugs; and 25.1% included a non-nucleoside reverse transcriptase inhibitor (NNRTI). Also, 9.5% included at least one drug from each of 3 classes. Of 3rd HAART (or 2nd salvage) regimens (n = 213): only 36.6% were single PI with 2 NRTI's, 31.9% included dual PI's, 48.4% were >3 drugs, 51.2% had an NNRTI, 28.6% had at least 1 drug from each of 3 classes. Mean duration of time spent on 1st , 2nd , and 3rd HAART were 10.6, 8.1, and 6.4 months, respectively.

CONCLUSIONS: Sustained low rates of AIDS-related morbidity and mortality, reductions in VL and increases in CD4+ cells count, continue to be observed in association with a high prevalence of HAART usage, especially PI-based regimens. Increasingly complex HAART regimens, containing numerous agents from different classes, are most often prescribed when going from initial through sequential salvage regimens, with progressively less time spent on each subsequent regimen.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, HIV Infections, CD4 Lymphocyte Count, Viral Load, Reverse Transcriptase Inhibitors, HIV Protease Inhibitors, Anti-HIV Agents, Acquired Immunodeficiency Syndrome, HIV, Incidence, Prevalence, Human, mortality, Epidemiology
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ThOrC723