SURVIVAL FROM EARLY, INTERMEDIATE, AND LATE STAGES OF HIV-INFECTION

Objective.-To estimate expected survival time among homosexual men inf ected with the human immunodeficiency virus type 1 (HIV-1) by (1) the calendar period before (1985-1988) and after (1989-1993) the widesprea d availability of acquired immunodeficiency syndrome (AIDS) treatments with antiretroviral and prophylactic interventions, acid (2) stage of HIV disease. Design.-A prospective cohort study. A group of HIV-1-inf ected homosexual men were followed from July 1985 through June 1993 an d evaluated every 6 months for the presence of clinical symptoms and m easurement of the CD4 cell count, To measure the effectiveness of AIDS therapies in this nonrandomized study, we used 2 calendar periods as proxy measures of relative intensity of exposure to antiretroviral the rapy. Stage of infection was defined by CD4 cell count and presence of HIV-related clinical symptoms or AIDS. Setting and Study Participants .-Homosexual men infected with HIV-1 from the Multicenter AIDS Cohort Study. Main Outcome Measure.-Survival time based on stage of HIV infec tion. Results.-The percentage of HIV-1-infected individuals free of AI DS and clinical symptoms at baseline who survived 2.5 years according to baseline CD4 cell counts of 0 to 0.100, 0.101 to 0.200, and 0.201 t o 0.350 x 10(9)/L was 22%, 53%, and 83%, respectively, for the 1985-19 88 calendar period, compared with 54%, 71%, and 91%, respectively, for men in the 1989-1993 calendar period. Among men free of AIDS with CD4 cell counts of greater than 0.350 x 10(9)/L, the relative hazard of m ortality was 1.6 to 2.3 times higher for those with clinical symptoms compared with those free of clinical symptoms. Conclusions.-Survival o f AIDS-free HIV-1-infected individuals with CD4 cell counts of less th an 0.350 x 10(9)/L has improved since antiretroviral and HIV prophylac tic treatments have become available, but the long-term prognosis rema ins poor.