Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy

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Abstract
Objective: To characterize the temporal changes in mortality and life expectancy among HIV-positive individuals initiating antiretroviral therapy in British Columbia, Canada, from 1993 to 2004. Methods: This analysis was restricted to 2238 antiretroviral-naive HIV-positive individuals who started antiretroviral therapy between January 1993 and September 2004. The primary analysis endpoint was all-cause mortality stratified by four time periods: 1993–1995, 1996–1998, 1999–2001, and 2002–2004. Cox proportional hazard models, with associated 95% confidence intervals (CI), were used to estimate the hazard of death. Abridged life tables were constructed to compare life expectancies at the age of 20 years. Results: Product limit estimates of the cumulative mortality rate at 12 months after therapy initiation decreased from 15.8% (± 1.6%) in 1993–1995 to 6.1% (± 1.1%) in 2002–2004. Life expectancy at the age of 20 years has increased from 9.1 years (± 2.3 years) in 1993–1995 to 23.6 years (± 4.4 years) in 2002–2004. Subjects in 1993–1995 were more likely to die than those who started therapy in 2002–2004 (hazard ratio 2.78; 95% CI 1.92–3.85). Patients who initiated dual therapy or therapies containing three or more antiretroviral drugs were, respectively, 1.49 (95% CI 1.23–1.82) and 2.56 (95% CI 2.13–3.13) times less likely to die than those who started on monotherapy. Conclusion: A significant and progressive decrease in mortality and increase in life expectancy were observed over the 12-year study period. The increase in life expectancy and decrease in mortality were directly associated with the use of modern forms of HAART.