AEGiS-14IAC: Factors associated with survival and progression to AIDS before and after the introduction of HAART.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Factors associated with survival and progression to AIDS before and after the introduction of HAART.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrC1444)

Pezzotti P, Dorrucci M, Sinicco A, Angarano G, Zazzara M, Mazzarello G, Cusini M, Rezza G
Istituto Superiore di Sanita, Roma, Italy

BACKGROUND: We evaluated the risk of progressing to death and AIDS by calendar period and by age at seroconversion, exposure category, and gender, before and after the introduction of HAART.

METHODS: We conducted a prospective cohort study (Italian Seroconversion Study) of HIV-infected persons with an estimated date of seroconversion, considered as time-zero of analysis. A Cox model allowing for staggered entries was used to estimate the RH of death and AIDS in the periods 1980-1996, 1997-1998 (reference), and 1999-2000. To evaluate simultaneously the role of age at seroconversion, gender, and exposure category before and after the introduction of HAART, we performed multivariate analyses for the periods before and after January 1997.

RESULTS: We followed 1,847 persons for a median of 8.6 years. During this period 601 developed AIDS and 469 died. The median age at seroconversion was 27.0 years; 53.0% were injecting drug users (IDU), 26.5% men who have sex with men (MSM), and 20.5% heterosexual contacts, 30.6% of whom were women. Since the RHs of death and AIDS were consistently very similar, only the data for AIDS are shown here. The RH of AIDS was 2.33 (95% CI: 1.79-3.04) in 1980-1996, and 0.30 (0.19-0.47) in 1999-2000, compared to 1997-1998. Before HAART, the RH of AIDS was 1.43 (1.28-1.60) per 10-year increment in age at seroconversion, 1.07 (0.86-1.33) for women vs. men, 0.93 (0.74-1.16) for MSM vs. IDUs, and 1.03 (0.80-1.33) for heterosexual contacts vs. IDUs. After the introduction of HAART, the RH of AIDS was 1.44 (1.08-1.93) per 10-year increment in age at seroconversion, 0.82 (0.51-1.32) for women, 0.27 (0.14-0.51)] for MSM, and 0.45 (0.24-0.49) for heterosexual contacts.

CONCLUSIONS: The beneficial effects of HAART seem to be increasing with time. However, since the introduction of HAART, the risk of death and AIDS has apparently increased for IDUs, possibly as a result of poor adherence to therapy.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Proportional Hazards Models, Cohort Studies, HIV Infections, Heterosexuality, Survival Analysis, Survival, Prospective Studies, Cause of Death, Human, Female, Male, mortality

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ThOrC1444