Dramatically declining morbidity and mortality in Ambulatory HIV-infected patients

Frank Joseph Palella Jr*, A. Moorman, K. Delaney, M. Loveless, J. Fuhrer, D. Aschman, S. Holmberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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 languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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