HAART Has Reduced AIDS-Related Death Rates by 80% Since 1997, Study Says
Highly active antiretroviral therapy has reduced AIDS-related death rates by more than 80% and increased life expectancy for HIV-positive people taking the drugs to more than 10 years, according to a study published in the Oct. 18 issue of the Lancet, Reuters reports (Reaney, Reuters, 10/17). Lead investigator Dr. Kholoud Porter of the British Medical Research Council and colleagues analyzed the findings of 22 cohort studies from Europe, Australia and Canada that were part of the Concerted Action on SeroConversion to AIDS and Death in Europe, or CASCADE, study. Researchers compared the effects of age at seroconversion -- the point at which HIV is detectable in the blood stream -- exposure category, sex and presentation in three time periods: before 1997 -- when HAART was introduced; between 1997 and 1998 -- when there was "limited use" of HAART; and between 1999 and 2001 -- when there was widespread use of HAART. Researchers found that compared with pre-1997 data, death rates were reduced by 50% in 1997 and were 80% lower by 2001. HAART use increased from 22% in 1997 to 57% in 2001 (MRC release, 10/16).
Age, Drug Use
Researchers also found that before HAART, HIV-positive individuals who were diagnosed in their 40s and 50s had a lower life expectancy following diagnosis -- six to eight years -- compared with people who were diagnosed in their 20s and 30s, who had an average life expectancy of 11 years following diagnosis. However, after the introduction of HAART, nine out of 10 HIV patients have a 10-year life expectancy "regardless of how old they were at the time of infection," London's Independent reports. Researchers also found that injection drug users who contracted HIV through sharing needles were four times more likely to die of AIDS-related complications than men who became infected through sexual contact, and hemophiliacs infected with contaminated blood products were three times more likely to die of AIDS-related complications than men who contracted HIV sexually (Laurance, Independent, 10/17). Porter said, "Before age mattered, now it doesn't. Before, exposure category or risk group didn't matter and now it does" (Reuters, 10/17). Porter added that the findings "do point to the importance of an early diagnosis so that people can access the best treatments at the right time. We also need to continue to explore what happens when therapy starts to fail, for example due to resistance to antiretroviral drugs, if we are to maintain improved life expectancy for people living with HIV" (Independent, 10/17).
Julian Meldrum of the British AIDS organization Aidsmap said, "The good news is that it appears that so far the effects of HAART are not wearing off. In the future, the drugs will improve yet further, and there should be fewer side effects, making it easier to adhere to the therapy," adding, "There are certainly grounds for optimism." Martin Kirk of the AIDS charity Terrence Higgins Trust said, "We must remember that of all the people who will die this year with AIDS-related illnesses, a third will do so just three months after diagnosis. This is because they tested too late for treatments to be effective. There is still work to be done to encourage people to test for HIV, and remind them that it [need not] be a death sentence" (BBC News, 10/17).