Delayed death and AIDS progression in an Asian cohort of advanced HIV disease patients in the HAART era.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1162)
Lee KC, Wong KH, Chan KC, Lee SS, Chan MK Integrated Treatment Centre, Department of Health, Hong Kong, China
Background Western countries have witnessed decreased AIDS morbidity and mortality with the advent of highly active antiretroviral therapy (HAART). We examined progression to AIDS and/or death in advanced HIV disease patients in Hong Kong, in the pre-HAART and HAART era. Methods We retrospectively studied 1074 non-perinatally infected adult (age >13) HIV/AIDS patients seen at our clinic from 1984 to mid 2003. Pre-HAART era refers to pre-1997. Impact of treatment era, demography and CD4 levels at HIV or AIDS diagnosis was assessed for 3 clinical end-points: death in AIDS patients, AIDS progression in patients with CD4<200/ul and death in patients with CD4<200/ul. Results Of 487 and 587 HIV patients diagnosed in the pre-HAART and HAART era, 176 (36.1%) and 140 (23.9%) had progressed to AIDS respectively. Incidence of AIDS mortality, AIDS progression in CD4<200/ul patients and death in CD4<200/ul patients in the pre-HAART and HAART era were 52.3% vs. 13.6%, 47.7% vs. 20.9% and 38.8% vs. 7.0% respectively (P<0.001 for all). Median survival after AIDS increased from 29.1 months in pre-HAART era to over 70 months in the HAART era (P<0.001). In the pre-HAART era, median durations to AIDS and death after CD4<200/ul in the pre-HAART and HAART era were 47.7 months vs. >130 months (P=0.0063) and >120 months vs. >130 months (P<0.001) respectively. Compared with pre-HAART era, hazard ratios (HR) of clinical events in HAART era patients were 0.19 [95% CI 0.10-0.35] for post-AIDS death, HR 0.28 [95% CI 0.17-0.46] for AIDS progression after CD4<200/ul and 0.25 [95% CI 0.15-0.40] for death after CD4<200/ul) respectively. Conclusions Clinical outcomes of advanced HIV disease patients in Hong Kong had significantly improved in the HAART era. Our findings in terms of extended survival and AIDS-free status may be relevant to the expected health impacts from expanding access to HAART in Asian countries.
Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Incidence, Death, Treatment Outcome, Hong Kong, Adult, Humans, epidemiology
