DECLINING MORBIDITY AND MORTALITY AMONG PATIENTS WITH ADVANCED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Background and Methods National surveillance data show recent, marked reductions in morbidity and mortality associated with the acquired imm unodeficiency syndrome (AIDS). To evaluate these declines, we analyzed data on 1255 patients, each of whom had at least one CD4+ count below 100 cells per cubic millimeter, who were seen at nine clinics special izing in the treatment of human immunodeficiency virus (HIV) infection in eight U.S. cities from January 1994 through June 1997. Results Mor tality among the patients declined from 29.4 per 100 person-years in 1 995 to 8.8 per 100 person-years in the second quarter of 1997. There w ere reductions in mortality regardless of sex, race, age, and risk fac tors for transmission of HIV. The incidence of any of three major oppo rtunistic infections (Pneumocystis carinii pneumonia, Mycobacterium av ium complex disease, and cytomegalovirus retinitis) declined from 21.9 per 100 person-years in 1994 to 3.7 per 100 person-years by mid-1997. In a failure-rate model, increases in the intensity of antiretroviral therapy (classified as none, monotherapy, combination therapy without a protease inhibitor, and combination therapy with a protease inhibit or) were associated with stepwise reductions in morbidity and mortalit y. Combination antiretroviral therapy was associated with the most ben efit; the inclusion of protease inhibitors in such regimens conferred additional benefit. Patients with private insurance were more often pr escribed protease inhibitors and had lower mortality rates than those insured by Medicare or Medicaid. Conclusions The recent declines in mo rbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies. (C) 1998, Massachusetts Medical So ciety.