Survival After AIDS Diagnosis Increased With Introduction of Antiretroviral Therapy, Study Finds
Americans diagnosed with AIDS in 1997 could expect to live nearly three years longer than those who were diagnosed in the mid 1980s, according to a study published in today's Journal of the American Medical Association. Reuters Health reports that researchers from the CDC, led by Dr. Lisa Lee, found that half of all adults and adolescents diagnosed with AIDS in 1995 lived for 46 months or more after diagnosis, compared to 11 months for those who were diagnosed in 1984. Survival time increased every year for all ethnic groups (Rostler, Reuters Health, 3/13). Researchers analyzed data, recorded in the national HIV/AIDS surveillance system at the CDC, including adult and adolescent AIDS cases diagnosed between 1984 and 1997 and reported through December 1999 in all 50 states, Washington, D.C., and all U.S. dependencies and possessions. The study excluded people who were diagnosed and died within the same month because they contributed "no measurable survival time." From 1984 to 1997, the 394,705 reported AIDS cases showed that survival time improved with each successive year after initial diagnosis with the greatest difference appearing between 1994, when survival time was estimated at 21 months, and 1995, when survival estimates increased to 46 months. Researchers attribute the increase to the introduction of antiretroviral therapies including protease inhibitors. The percentage of patients receiving combination therapy increased from 0% in 1993 to 40% in 1997 in one study and to 65% in another. Survival time could not be determined for those diagnosed in 1996 and 1997 because fewer than half had died by December 1998. Racial differentials appeared in a "synthesis of five survival analyses," but disappeared when analyses accounted for socioeconomic difference and other characteristics, such as risk exposure. The population-level data showed "small but statistically significant" differences in survival probability between racial groups, but all groups showed a "similar pattern of improvement." There was no observed difference in survival between the sexes. The study cites "underascertainment" of deaths as one possible limitation of the analysis. Researchers also note that their primary analysis took place after the 1993 change in the AIDS surveillance case definition to include "severe immunodeficiency," usually diagnosed at an earlier stage of HIV infection, meaning that life span may appear longer (Lee et al., JAMA, 3/14).
Public Health Challenge
The study also notes that increased survival times will present a public health challenge. In an interview with Reuters Health, Lee said that people living with AIDS will need "ongoing support" to help them avoid "risky" sex and drug behaviors and follow complex drug regimens. "It will be important to develop strategies to help patients adhere in the long term and to develop regimens that are [easier] to take," she said. And while the study shows good results for Americans with access to AIDS medications, Dr. Paolo Miotti, chief of epidemiology in the AIDS division of the National Institute of Allergy and Infectious Diseases, cautioned against applying the results to the developing world. "[W]e have to be careful about extrapolating the results to other countries," he said. Medication side effects and "complicated" regimens make close patient monitoring necessary, something that is "very difficult to handle even in the U.S.," he added (Reuters Health, 3/13).