About a third of HIV-positive patients in the current treatment era who develop their first opportunistic illness die within five years, according to a study analyzing 30 years of data from over 20,000 patients in San Francisco. While the finding highlights the dramatic reduction of AIDS-related deaths after the advent of antiretroviral therapy (ART), it also underscores the need for more improvement.
The study, published in the Journal of Infectious Diseases, examined five-year survival probability after first AIDS-defining opportunistic illness (AIDS-OI), during three distinct treatment eras: pre-ART (1981-1986), mono/dual ART (1987-1996), and combination ART (1997-2012).
With the introduction of antiretroviral therapy, the survival rate after first AIDS-OI has gone up significantly:
- pre-ART (1981-1986): 7%
- mono/dual ART (1987-1996): 18%
- combination ART (1997-2012): 65%
Overall the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi's sarcoma (20.1%). Additionally, after adjusting for confounding factors, mortality rates were highest for brain lymphoma and progressive multifocal leukoencephalopathy.
"While recent research suggests that many opportunistic infections in the U.S. are now less common and, oftentimes, less lethal, we cannot forget about them," said lead study author Kpandja Djawe, Ph.D., of the Centers for Disease Control and Prevention (CDC), according to the study press release. "We need to keep them in mind, even in the context of the changing epidemiology of HIV," he added.
"Better prevention and treatment strategies, including earlier HIV diagnosis, are needed to lessen the burden of AIDS opportunistic infections, even today, in the combination ART era," said Sandra Schwarcz, M.D., senior HIV epidemiologist at the San Francisco Department of Public Health and fellow study author.