Combination Antiretroviral Therapy and Recent Declines in AIDS Incidence and Mortality

• Published in: The Journal of infectious diseases Vol. 179; no. 3; pp. 717 - 720
• Main Authors: Vittinghoff, Eric, Scheer, Susan, O'Malley, Paul, Colfax, Grant, Holmberg, Scott D., Buchbinder, Susan P.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University Chicago Press 01.03.1999; University of Chicago Press; Oxford University Press
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - mortality; AIDS; AIDS/HIV; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretrovirals; Antiviral agents; Biological and medical sciences; Bisexual males; Concise Communications; Confidence Intervals; Death; Disease Progression; Drug Therapy, Combination; Health hazards; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - mortality; HIV Seropositivity - epidemiology; Homosexuality, Male; Human immunodeficiency virus; Humans; Incidence; Infections; Male; Male homosexuality; Medical sciences; Mortality; Pharmacology. Drug treatments; Proportional Hazards Models; Public health; San Francisco - epidemiology; San Francisco; Human; Immunopathology; Drug combination; Treatment efficiency; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Chemotherapy; Treatment; Viral disease; Antiviral; Human immunodeficiency virus
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/314623

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.