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Article
May 1, 1996

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

Author Affiliations

From the Department of Oncology, The Johns Hopkins School of Medicine, Baltimore, Md (Dr Enger); Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Drs Graham and Muñoz and Ms Peng); Department of Preventive Medicine, Northwestern University Medical School, Chicago, Ill (Dr Chmiel); Department of Infectious Diseases and Microbiology, University of Pittsburgh (Pa) Graduate School of Public Health (Dr Kingsley); and Department of Epidemiology, UCLA School of Public Health, Los Angeles, Calif (Dr Detels).

JAMA. 1996;275(17):1329-1334. doi:10.1001/jama.1996.03530410043031
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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