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Volume 338:853-860 March 26, 1998 Number 13 Next

	Full Text PDF Editorial by Hirschel, B. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods National surveillance data show recent, marked reductions in morbidity and mortality associated with the acquired immunodeficiency syndrome (AIDS). To evaluate these declines, we analyzed data on 1255 patients, each of whom had at least one CD4+ count below 100 cells per cubic millimeter, who were seen at nine clinics specializing in the treatment of human immunodeficiency virus (HIV) infection in eight U.S. cities from January 1994 through June 1997.

Results Mortality among the patients declined from 29.4 per 100 person-years in 1995 to 8.8 per 100 person-years in the second quarter of 1997. There were reductions in mortality regardless of sex, race, age, and risk factors for transmission of HIV. The incidence of any of three major opportunistic infections (Pneumocystis carinii pneumonia, Mycobacterium avium complex disease, and cytomegalovirus retinitis) declined from 21.9 per 100 person-years in 1994 to 3.7 per 100 person-years by mid-1997. In a failure-rate model, increases in the intensity of antiretroviral therapy (classified as none, monotherapy, combination therapy without a protease inhibitor, and combination therapy with a protease inhibitor) were associated with stepwise reductions in morbidity and mortality. Combination antiretroviral therapy was associated with the most benefit; the inclusion of protease inhibitors in such regimens conferred additional benefit. Patients with private insurance were more often prescribed protease inhibitors and had lower mortality rates than those insured by Medicare or Medicaid.

Conclusions The recent declines in morbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies.

Source Information

From Northwestern University Medical School, Chicago (F.J.P.); the Health Research Network of Apache Medical Systems, Chicago (K.M.D., D.J.A.); the Centers for Disease Control and Prevention, Atlanta (A.C.M., G.A.S., S.D.H.); Oregon Health Sciences University, Portland (M.O.L.); and the State University of New York, Stony Brook (J.F.).

Address reprint requests to Dr. Palella at Northwestern University Medical School, 303 E. Superior St., Passavant Pavilion, Rm. 828, Chicago, IL 60611-0949.

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