Combination antiretroviral therapy and recent declines in AIDS incidence and mortality

J Infect Dis. 1999 Mar;179(3):717-20. doi: 10.1086/314623.

Abstract

The reasons for recent declines in AIDS incidence and mortality may include advances in treatment, but these may be confounded by earlier declines in the incidence of human immunodeficiency virus (HIV) infection. To determine whether the declines in AIDS and mortality may, in part, stem from wider use of combination antiretroviral therapy, 622 HIV-positive men with well-characterized dates of seroconversion were followed. In this group, combination therapy came into widespread use in only 1996. In a Cox proportional hazards model, the 1996 calendar period was significantly associated with slower progression to AIDS (relative hazard [RH]=0. 19, 95% confidence interval [CI], 0.05-0.69, P=.01) and death (RH=0. 45, 95% CI, 0.21-0.95, P=.04). Declines in incidence of HIV infection, changes in HIV virulence, and end-point underreporting cannot fully explain the decline in AIDS and death in 1996. The introduction of combination antiretroviral therapy as the standard of care may already have had measurable effects.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / epidemiology*
  • Acquired Immunodeficiency Syndrome / mortality
  • Anti-HIV Agents / therapeutic use*
  • Confidence Intervals
  • Disease Progression
  • Drug Therapy, Combination
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • HIV Infections / mortality
  • HIV Seropositivity / epidemiology
  • Homosexuality, Male
  • Humans
  • Incidence
  • Male
  • Proportional Hazards Models
  • San Francisco / epidemiology

Substances

  • Anti-HIV Agents