CHANGES IN SURVIVAL AFTER ACQUIRED-IMMUNODEFICIENCY-SYNDROME (AIDS) -1984-1991

In a prospective cohort of 2,647 human immunodeficiency virus type 1 ( HIV-1) seropositive homosexual men enrolled in Baltimore, Chicago, Los Angeles, and Pittsburgh, 891 developed clinical acquired immunodefici ency syndrome (AIDS) between June 1984 and January 1992. Cox proportio nal hazards models were used to examine temporal trends in survival af ter AIDS for specific diagnoses, controlling for level of immunosuppre ssion at diagnosis, age, race, and geographic location. Median surviva l time following AIDS onset increased from 11.6 months in 1984-1985 to 19.5 months in 1988-1989; for those diagnosed in 1990-1991, the media n survival time dropped to 17.2 months. Trends in improved survival we re diagnosis-specific. Survival after Pneumocystis carinii pneumonia c onsistently improved from 1984 to 1991 (p < 0.001). Compared with men diagnosed in 1984-1985, those diagnosed with P. carinii pneumonia in 1 990-1991 had one-tenth the hazard of dying. For men with greater than or equal to 100 helper T-lymphocytes (CD4+ cells) when diagnosed with Kaposi's sarcoma, the relative hazards (95% confidence intervals) of d ying after Kaposi's sarcoma were 0.8 (0.42-1.60) in 1986-1987, 0.7 (0. 34-1.58) in 1988-1989, and 0.6 (0.19-1.61) in 1990-1991 compared with those diagnosed before 1986. Men with <100 CD4+ cells when diagnosed w ith Kaposi's sarcoma did not demonstrate a consistent change in their subsequent survival. After a nonsignificant (p > 0.05) initial improve ment in prognosis, there has not been a significant improvement in sur vival for men who presented with other opportunistic infections. Obser ved increases in overall survival probably relate to improved treatmen t of patients who develop P. carinii pneumonia. Limited improvement in survival following other AIDS diagnoses indicates the need for develo ping effective treatment against these diseases.