Survival From Early, Intermediate, and Late Stages of HIV Infection

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Abstract
Objective. —To estimate expected survival time among homosexual men infected with the human immunodeficiency virus type 1 (HIV-1) by (1) the calendar period before (1985-1988) and after (1989-1993) the widespread availability of acquired immunodeficiency syndrome (AIDS) treatments with antiretroviral and prophylactic interventions, and (2) stage of HIV disease. Design. —A prospective cohort study. A group of HIV-1—infected homosexual men were followed from July 1985 through June 1993 and evaluated every 6 months for the presence of clinical symptoms and measurement of the CD4 cell count. To measure the effectiveness of AIDS therapies in this nonrandomized study, we used 2 calendar periods as proxy measures of relative intensity of exposure to antiretroviral therapy. Stage of infection was defined by CD4 cell count and presence of HIV-related clinical symptoms or AIDS. Setting and Study Participants. —Homosexual men infected with HIV-1 from the Multicenter AIDS Cohort Study. Main Outcome Measure. —Survival time based on stage of HIV infection. Results. —The percentage of HIV-1—infected individuals free of AIDS and clinical symptoms at baseline who survived 2.5 years according to baseline CD4 cell counts of 0 to 0.100, 0.101 to 0.200, and 0.201 to 0.350× 109/L was 22%, 53%, and 83%, respectively, for the 1985-1988 calendar period, compared with 54%, 71%, and 91%, respectively, for men in the 1989-1993 calendar period. Among men free of AIDS with CD4 cell counts of greater than 0.350× 109/L, the relative hazard of mortality was 1.6 to 2.3 times higher for those with clinical symptoms compared with those free of clinical symptoms. Conclusions. —Survival of AIDS-free HIV-1—infected individuals with CD4 cell counts of less than 0.350× 109/L has improved since antiretroviral and HIV prophylactic treatments have become available, but the long-term prognosis remains poor. (JAMA. 1996;275:1329-1334)

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