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British Columbia Researchers Examine Past and Future Directions in the HIV Epidemic

February 25, 2015

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Researchers at the British Columbia Centre for Excellence in HIV/AIDS (CfE) in Vancouver have amassed extensive health-related data collected from HIV-positive people. These data have been stripped of information that could be used to identify individual patients. From time to time this data is analysed to produce reports. Recently, researchers at the CfE sought to examine trends in AIDS-related illnesses (infections, cancers and complications) between 1981 and 2013. They found that rates of AIDS-related illnesses and deaths fell once potent combination anti-HIV therapy (commonly called ART or HAART) became available in the mid-to-late 1990s. Data from the CfE has also contributed to many reports, including one that predicts near-normal life span for some HIV-positive people.

In its latest report, published in the journal Lancet HIV, the CfE team underscores the importance of comprehensive barrier-free access to the offer of HIV testing, counselling, and swift referral to care (in cases where test results are positive), followed by the offer of treatment as well as ongoing care and monitoring. The B.C. team states that such comprehensive services have helped to make massive progress against AIDS. However, they note that further investment in such services is needed to sustain progress and to further reduce the spread of HIV.


Study Details

Researchers restricted their analyses to people aged 19 years or older at the time they entered the study and analysed health-related information from January 1981 to December 2013, or until participants died.

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Researchers divided their data into the following periods:

  • 1981 to 1996 -- before the rollout of ART
  • 1996 to 1999 -- the initial rollout of ART
  • 2000 to 2003 -- stable increase in initiation of ART
  • 2004 to 2012 -- the second rollout of ART

The research team reviewed data from at least 3,097 men and 453 women with AIDS.


Results -- Age and Infections

The average age at the time of participants' first AIDS-related illness was 41 years. In the CfE study, each person had an average of two AIDS-related illnesses, though some people had as many as seven.


Peak of AIDS

The peak of cases of AIDS occurred in 1994. In that year there were about 42 cases of AIDS per 100 participants. By 1997, with the initial rollout of ART underway, there were seven cases of AIDS per 100 participants. By 2013 there was only one case of AIDS per 100 participants. This is tremendous progress.


Gender

Throughout the study, researchers found that more men than women had HIV and, not surprisingly, more men had AIDS-related infections. In 1991 the ratio of men to women who had AIDS was nearly 50:1. By 1996 the ratio had fallen to 10:1 and by 2013 the ratio was 3:1. This massive decrease was driven by fewer men experiencing AIDS because more were taking ART.


Revisiting Age

The CfE researchers noticed that beginning in 2004, AIDS-related illnesses were most common in people between the ages of 40 and 49. They added that "more recently" AIDS is now most concentrated in people aged 50 years and older.


AIDS in 2013

Among people who were aged 50 years and older and who developed AIDS in 2013, here are some common AIDS-related illnesses that occurred:

  • severe unintentional weight loss (HIV wasting syndrome)
  • non-Hodgkin lymphoma
  • tuberculosis
  • severe yeast infection (caused by Candida) of the throat and airways of the lungs
  • dementia


Compare and Contrast

In the pre-ART era, common AIDS-related illnesses included the following:

  • Pneumocystis pneumonia (PCP) -- a disease caused by Pneumocystis jirovecii, formerly called Pneumocystis carinii
  • Kaposi's sarcoma (KS)
  • MAC (Mycobacterium avium complex)
  • Candida infection of the throat, airways of the lungs and in some cases, all of the lungs
  • HIV wasting syndrome

After ART became available, common AIDS-related illnesses were as follows:

  • PCP
  • HIV wasting syndrome
  • lymphomas (including non-Hodgkin, Burkitt's, immunoblastic and others)
  • KS
  • Candida of the throat and lungs
  • recurring bacterial infections
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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