Substantial Increase In Survival After Introduction Of Highly Active Antiretroviral Therapy For HIV-1 Infection

Research published in this week’s issue of THE LANCET highlights the substantial increased survival for people with HIV-1 since the introduction of highly active antiretroviral therapy (HAART) in 1997. However the study also shows a shift in risk profiles compared with earlier data-people over 45 years no longer appear to have reduced survival compared with younger people, and individuals who acquire HIV-1 infection from injecting drug use have mortality rates four times greater than infection acquired from homosexual contact.

Using data from a large collaboration of 22 studies in Europe, Australia, and Canada (CASCADE), Kholoud Porter from the UK Medical Research Council Clinical Trials Unit and colleagues assessed the continuing effect of HAART on survival and progression to AIDS after HIV-1 seroconversion (the point at which antibodies to HIV-1 infection are detectable in blood). The investigators compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).

Compared with pre-1997 data, death rates were reduced by 50% in 1997, and by over 80% by 2001; during this time use of HAART therapy increased from 22% in 1997 to 57% in 2001. The largest reduction in mortality occured soon after HAART first became available in 1997.

By contrast with the pre-HAART era, injecting drug users had death rates four times greater in 1999-2001 than men infected through homosexual contact. Whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years, there was little evidence of a difference in risk by age in 1999-2001.

Kholoud Porter comments: “Now that HAART therapy is available, 9 out of 10 people infected with HIV-1 can expect to survive more than 10 years, regardless of their age. Earlier diagnosis provides opportunities to maximise gains from the advances in clinical practice that have occurred since 1997.”