AEGiS-14IAC: In the HAART era AIDS occurs mainly in patients unaware of HIV serostatus (AIDS-presenters) or refusing antiretroviral treatment.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

In the HAART era AIDS occurs mainly in patients unaware of HIV serostatus (AIDS-presenters) or refusing antiretroviral treatment.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10714)

Castelnuovo B, Rusconi S, Chiesa E, Melzi S, Bongiovanni M, Cicconi P, Tordato F, Sollima S, Meroni L, Bini T, d'Arminio Monforte A
Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy

BACKGROUND: Our study evaluated AIDS trends and predictive factors of AIDS in patients (pts) unaware of HIV infection at AIDS diagnosis (AP), and in known HIV-positive subjects (nAP), either naïve (nOT) or on treatment (OT).

METHODS: Cohort study including 3,483 pts followed at our Institute from 1/1/1993 to 31/12/2000. Two periods were considered: 1993-1996 and 1997-2000. We calculated AIDS incidence in HIV population and according to gender, age (≤ or >49 years [yrs]) and heterosexual (HS) behaviour as risk factor for HIV. A linear regression multivariate analysis was performed to find variables associated to AP. Within AIDS pts prevalence of AP, OT and nOT was calculated and linear regression multivariate analyses performed to find predictive factors of being AP or nOT.

RESULTS: AIDS incidence decreased over time (95.49/1000 persons year [PY] vs 50.67/1000 PY before and after 1997), due mainly to OT pts (112.28/1000 PY vs 26.5/1000 PY). AIDS incidence in AP was 13.5 and 16.5/1000 PY and much higher in elders (>49 yrs) and HS pts (53.5 and 52.4/1000 PY and 28.8 and 21.5/1000 PY respectively). Factors associated to a higher risk of being AP were male gender (AHR 1.45), age 25-30 or >30 yrs at AIDS diagnosis (AHR 4.09 and 7.59 respectively) and yr of HIV diagnosis (AHR 1.263 per yr from 1993 to 2000). In AIDS population, AIDS prevalence decreased in OT (from 50.1% to 39.7%) and in nOT (from 36.1% to 27.8%), but increased in AP (from 13.8% to 32.5%). Variables predictive of being AP among AIDS pts were male gender (AHR 1.78), age at diagnosis (AHR 1.02 per additional yr) and diagnosis in 1997-2000 (AHR 2.31). HS pts had a higher risk of being AP (AHR 5.75), and a lower risk of being nOT (AHR 0.04) than IVDU.

CONCLUSIONS: Since HAART introduction most AIDS cases occur in subjects unaware of being HIV-positive, especially males, elders and heterosexually infected, or refusing therapy, mainly IVDU who don't refer to specialised centres.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Incidence, Prevalence, Risk Factors, Cohort Studies, Drug Therapy, Combination, Human, Male, therapy, drug therapy

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