Objectives and Methods; To evaluate trends in morbidity and mortality among HIV-infected individuals, we analyzed data electronically charted from outpatient visits of 2957 patients in 8 private and 2 public HIV clinics from 1/94 through 12/96. Results: We calculated quarterly death rates and AIDS-defining opportunistic infection (OI) incidence rates among patients with fewer than 100 CD4+ T-lymphocytes. the average quarterly death rate was 6,1% among 485 patients observed in 1994; 6.9% among 743 patients in 1995; and 3.9% among 668 patients in 1996. During the last 2 quarters of 1996 death rates declined to 2.8% and 2.0%. The average quarterly incidence rates for AIDS Ols were: 18.5% in 1994, 18.0% in 1995, and 10.5% in 1996. During the last 2 quarters of 1996 OI incidence rates declined to 8.3% and 3.2%. During this period prescription rates for combination antiretroviral therapy (AR) among these patients increased from 15% first quarter (1st Q) 1994 to 92% 4th Q 1996. Use of combinations including a protease inhibitor (PI) increased from 20% 4th Q 1995 to 75% 4th Q 1996. Prophylaxis against p. carinii (>=93%) and M. avivm (54-58%) remained stable 1/94-12/96. Declines in morbidity and mortality, and increasing use of combination AR including PI, was seen in every demographic group: by gender, race, age, HIV risk, method of payment, and type of clinic. A Cox proportional hazards survival analysis stratified by AR category showed a substantial survival benefit conferred by PI exceeding that conferred by non-protease combination therapy, even when controlling for demographic factors and use of MAC chemoprophylaxis, equal regardless of whether or not the patients were antiretroviral naive. Conclusions: Dramatic declines in morbidity and mortality were temporally associated with increasing use of combination AR, particularly with protease inhibitors.
|Original language||English (US)|
|Number of pages||1|
|Journal||Clinical Infectious Diseases|
|State||Published - Dec 1 1997|
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases