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January 22, 1996

Effect of Comprehensive Intervention Program on Survival of Patients With Human Immunodeficiency Virus Infection

Arch Intern Med. 1996;156(2):169-176. doi:10.1001/archinte.1996.00440020071009

Background:  In October 1989, an early intervention program (EIP) for human immunodeficiency virus (HIV) infection was initiated in New Jersey to provide medical care and social services to the enrollees.

Objective:  To assess the overall effect of the EIP on the survival of HIV-infected patients.

Methods:  Patient information collected through June 30, 1993, was analyzed from the Jersey City Medical Center EIP clinic. Survival from enrollment to death was calculated for patients who received follow-up at the clinic (active) and for those who only had the enrollment visit (inactive). The data were matched with the New Jersey death certificate registry.

Results:  Of 938 patients enrolled from October 1989 to December 1991,767 had T-cell subsets determined within 3 months of enrollment: 641 patients were active and 126 were inactive. At entry, inactive patients had a lower median CD4+ T-cell count and were more likely to be symptomatic than active patients. Among the 640 active and 125 inactive patients analyzed for survival (survivors ≥2 months), there were 144 (22.5%) and 48 (38.4%) deaths, respectively. Kaplan-Meier analysis indicated longer survival for active patients than for inactive patients (P<.001, Wilcoxon's test for homogeneity of strata); eg, survival probability at 2 years was 86% for active patients and 64% for inactive patients. Active patients also had longer survival than inactive patients when stratified by CD4+ T-cell levels or by clinical status. Only active and inactive patients with both CD4+ T-cell levels lower than 0.20 ×109/L (<200/ μL) and symptoms of HIV or acquired immunodeficiency syndrome had similar survival rates. Survival was not influenced by sex, race, or HIV transmission category.

Conclusion:  Participation in the EIP was associated with longer survival of HIV-infected patients.(Arch Intern Med. 1996;156:169-176)