Improved Survival Among HIV-Infected Individuals Following Initiation of Antiretroviral Therapy
CONTEXT.— Clinical trials have established the efficacy of antiretroviral therapy with double- and triple-drug regimens for individuals infected with the human immunodeficiency virus (HIV), but the effectiveness of these regimens in the population of patients not enrolled in clinical trials is unkno...
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Published in | JAMA : the journal of the American Medical Association Vol. 279; no. 6; pp. 450 - 454 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
11.02.1998
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT.— Clinical trials have established the efficacy of antiretroviral therapy
with double- and triple-drug regimens for individuals infected with the human
immunodeficiency virus (HIV), but the effectiveness of these regimens in the
population of patients not enrolled in clinical trials is unknown. OBJECTIVE.— To characterize survival following the initiation of antiretroviral
therapy among HIV-infected individuals in the province of British Columbia. DESIGN.— Prospective, population-based cohort study of patients with antiretroviral
therapy available free of charge (median follow-up, 21 months). SETTING.— Province of British Columbia, Canada. PATIENTS.— All HIV-positive men and women 18 years of age or older in the province
who were first prescribed any antiretroviral therapy between October 1992
and June 1996 and whose CD4+ cell counts were less than 0.350×109/L. MAIN OUTCOME MEASURES.— Rates of progression from initiation of antiretroviral therapy to death
or a primary acquired immunodeficiency syndrome (AIDS) diagnosis for subjects
who initially received zidovudine-, didanosine-, or zalcitabine-based therapy
(ERA-I) and for those who initially received therapy regimens including lamivudine
or stavudine (ERA-II). RESULTS.— A total of 1178 patients (951 ERA-I, 227 ERA-II) were eligible. A total
of 390 patients died (367 ERA-I, 23 ERA-II), yielding a crude mortality rate
of 33.1%. ERA-I group subjects were almost twice as likely to die as ERA-II
group subjects, with a mortality risk ratio of 1.86 (95% confidence interval
[CI], 1.21-2.86; P=.005). After adjusting for Pneumocystis carinii and Mycobacterium
avium prophylaxis use, AIDS diagnosis, CD4+ cell count,
sex, and age, ERA-I participants were 1.93 times (95% CI, 1.25-2.97; P=.003) more likely to die than ERA-II participants. Among
patients without AIDS when treatment was started, ERA-I participants were
2.50 times (95% CI, 1.59-3.93; P<.001) more likely
to progress to AIDS or death than ERA-II participants. CONCLUSION.— The HIV-infected individuals who received initial therapy with regimens
including stavudine or lamivudine had significantly lower mortality and longer
AIDS-free survival than those who received initial therapy with regimens limited
to zidovudine, didanosine, and zalcitabine. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.279.6.450 |