CHANGING PATTERNS OF MORTALITY ACROSS EUROPE IN PATIENTS INFECTED WITH HIV-1

Background The introduction of combination antiretroviral therapy and protease inhibitors has led to reports of falling mortality rates amon g people infected with HIV-1. We examined the change in these mortalit y rates of HIV-1-infected patients across Europe during 1994-98, and a ssessed the extent to which changes can be explained by the use of new therapeutic regimens. Methods We analysed data from EuroSIDA, which i s a prospective, observational, European, multicentre cohort of 4270 H IV-1-infected patients. We compared death rates in each 6 month period from September, 1994, to March, 1998. Findings By March, 1998, 1215 p atients had died. The mortality rate from March to September, 1995, wa s 23.3 deaths per 100 person-years of follow-up (95% CI 20.6-26.0), an d fell to 4.1 per 100 person-years of follow-up (2.3-5.9) between Sept ember, 1997, and March, 1998. From March to September, 1997, the death rate was 65.4 per 100 person-years of follow-up for those on no treat ment, 7.5 per 100 person-years of follow-up for patients on dual thera py, and 3.4 per 100 person-years of follow-up for patients on triple-c ombination therapy. Compared with patients who were followed up from S eptember, 1994, to March, 1995, patients seen between September, 1997, and March, 1998, had a relative hazard of death of 0.16 (0.08-0.32), which rose to 0.90 (0.50-1.64) after adjustment for treatment. Interpr etation Death rates across Europe among patients infected with HIV-1 h ave been falling since September, 1995, and at the begining of 1998 we re less than a fifth of their previous level. A large proportion of th e reduction in mortality could be explained by new treatments or combi nations of treatments.