Changing patterns of mortality across Europe in patients infected with HIV-1

• Published in: The Lancet (British edition) Vol. 352; no. 9142; pp. 1725 - 1730
• Main Authors: Mocroft, A, Vella, S, Benfield, TL, Chiesi, A, Miller, V, Gargalianos, P, Monforte, A d'Arminio, Yust, I, Bruun, JN, Phillips, AN, Lundgren, JD
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 28.11.1998; Lancet; Elsevier Limited
• Subjects: Antiretroviral agents; Biological and medical sciences; Demographics; Health hazards; HIV; Human immunodeficiency virus; Human viral diseases; Infectious diseases; Medical sciences; Mortality; Proteinase inhibitors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Europe; Human; Immunopathology; Drug combination; Prognosis; HIV-1 virus; Mortality; Retroviridae; AIDS; Immune deficiency; Lentivirus; Epidemiology; Infection; Virus; Chemotherapy; Follow up study; Viral disease; Human immunodeficiency virus; Public health; Comparative study; Novelty
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(98)03201-2

The introduction of combination antiretroviral therapy and protease inhibitors has led to reports of falling mortality rates among people infected with HIV-1. We examined the change in these mortality rates of HIV-1-infected patients across Europe during 1994-98, and assessed the extent to which changes can be explained by the use of new therapeutic regimens. We analysed data from EuroSIDA, which is a prospective, observational, European, multicentre cohort of 4270 HIV-1-infected patients. We compared death rates in each 6 month period from September, 1994, to March, 1998. By March, 1998, 1215 patients had died. The mortality rate from March to September, 1995, was 23·3 deaths per 100 person-years of follow-up (95% Cl 20·6–26·0), and fell to 4·1 per 100 person-years of follow-up (2·3–5·9) between September, 1997, and March, 1998. From March to September, 1997, the death rate was 65·4 per 100 person-years of follow-up for those on no treatment, 7·5 per 100 person-years of follow-up for patients on dual therapy, and 3·4 per 100 person-years of follow-up for patients on triple-combination therapy. Compared with patients who were followed up from September, 1994, to March, 1995, patients seen between September, 1997, and March, 1998, had a relative hazard of death of 0·16 (0·08–0·32), which rose to 0·90 (0·50–1·64) after adjustment for treatment. Death rates across Europe among patients infected with HIV-1 have been falling since September, 1995, and at the begining of 1998 were less than a fifth of their previous level. A large proportion of the reduction in mortality could be explained by new treatments or combinations of treatments.