Continued improvement in survival among HIV-infected... : AIDS (original) (raw)

BASIC SCIENCE

Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy

Lima, Viviane Da; Hogg, Robert Sa,b; Harrigan, P Richarda,c; Moore, Davida; Yip, Benitaa; Wood, Evana; Montaner, Julio SGa,c

From the aBC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada

bFaculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada

cDepartments of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Received 23 August, 2006

Revised 6 October, 2006

Accepted 28 December, 2006

Correspondence to Viviane Dias Lima, PhD, HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, 608–1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Tel: +1 604 806 8796; fax: +1 604 806 9044; e-mail: [email protected]

Abstract

Objective:

To characterize the temporal changes in mortality and life expectancy among HIV-positive individuals initiating antiretroviral therapy in British Columbia, Canada, from 1993 to 2004.

Methods:

This analysis was restricted to 2238 antiretroviral-naive HIV-positive individuals who started antiretroviral therapy between January 1993 and September 2004. The primary analysis endpoint was all-cause mortality stratified by four time periods: 1993–1995, 1996–1998, 1999–2001, and 2002–2004. Cox proportional hazard models, with associated 95% confidence intervals (CI), were used to estimate the hazard of death. Abridged life tables were constructed to compare life expectancies at the age of 20 years.

Results:

Product limit estimates of the cumulative mortality rate at 12 months after therapy initiation decreased from 15.8% (± 1.6%) in 1993–1995 to 6.1% (± 1.1%) in 2002–2004. Life expectancy at the age of 20 years has increased from 9.1 years (± 2.3 years) in 1993–1995 to 23.6 years (± 4.4 years) in 2002–2004. Subjects in 1993–1995 were more likely to die than those who started therapy in 2002–2004 (hazard ratio 2.78; 95% CI 1.92–3.85). Patients who initiated dual therapy or therapies containing three or more antiretroviral drugs were, respectively, 1.49 (95% CI 1.23–1.82) and 2.56 (95% CI 2.13–3.13) times less likely to die than those who started on monotherapy.

Conclusion:

A significant and progressive decrease in mortality and increase in life expectancy were observed over the 12-year study period. The increase in life expectancy and decrease in mortality were directly associated with the use of modern forms of HAART.