Death Rates for HIV Patients Decrease Dramatically

TUESDAY July 1, 2008 -- Death rates for HIV-infected people lucky enough to get their hands on antiretroviral medications have decreased dramatically since the introduction of these drugs in 1996, new British research shows.

For most, the five-year, post-diagnosis survival for those infected sexually is now about equal to that of the general population.

Death rates were higher, however, for older individuals, for those who had been infected for a longer time, and for those who had been infected through intravenous drug use.

Dramatic declines in death rates for HIV-infected individuals following the introduction of highly active antiretroviral therapy (HAART) in industrialized nations in the mid-90s have already been documented.

"HIV is now a complex chronic disease," said Dr. Michael Horberg, director of HIV/AIDS at Kaiser Permanente Health Plan in Santa Clara, Calif. "And, if aggressively treated with accepted medications, we should expect to see mortality similar to the general population in that same demographic."

"[This information] will help health policy makers or those who monitor the effectiveness of treatments to forecast the impact of AIDS on health-care needs," said Srikanth Kolluru, an assistant professor of pharmaceutical sciences with the Texas A&M Health Science Center in Kingsville. "One important thing to know is that the composition of HAART regimen will keep changing for a particular patient during his/her course of therapy depending on the development of tolerance to the particular drug. Hence, newer drugs with different mechanisms of action are continuously needed to be added to HAART regimen to maintain the low mortality rate."

The authors of the current study, published in the July 2 issue of the Journal of the American Medical Association, updates existing information, deliberately focusing on people whose seroconversion rates were relatively well-established. Seroconversion refers to the time when antibodies to HIV appear in the blood, usually from one week to several months or more after actual infection.

More than 16,000 individuals in multiple countries were followed for a median of 6.3 years. During the follow-up period, 2,571 individuals with HIV infection died compared with 235 who would be expected to die in an equivalent general population.

The excess mortality rate decreased from 40.8 per 1,000 person-years before the introduction of HAART to 6.1 per 1,000 person-years in the 2004 to 2006 period.

There was essentially no excess mortality in the first five years after seroconversion among individuals who had been infected sexually. However, over the first 10 years, those aged 15 to 24 years old and those 45 years or over at seroconversion did have higher death rates.

The authors calculated an 88 percent reduction in excess mortality in 2000-2001 compared with the period prior to 1996. This was very close to the 87 percent reduction seen in 1997-2001. In 2004-2006, the excess mortality was 94 percent lower than pre-1996 levels.

The study did not take into account adherence to medication or side effects, which can be severe.

"The study doesn't take into account adverse events and medication adherence. And, over a longer time frame, we don't know if there might be an effect from medications accumulating in the body," Horberg said.

"Despite all these side effects [including diarrhea, nausea, vomiting, fat redistribution], HAART therapy still improves the quality of life and life expectancy, which is nearing close to that of uninfected population," Kolluru said. "Prevention is still the best treatment for AIDS, and that has no side effects."

More information

The U.S. Centers for Disease Control and Prevention have more on HIV/AIDS.

Posted: July 2008


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