Clinical spectrum, morbidity, and mortality of acquired immunodeficiency syndrome in Taiwan: A 5-year prospective study

The clinical spectrum of AIDS and changes of morbidity and mortality associ ated with HIV infection following initiation of highly active antiretrovira l therapy (HAART) are rarely described in the less developed countries in t he Asia-Pacific region. We prospectively observed on a follow-up basis 309 HIV-infected patients (82.8% with AIDS) at National Taiwan University Hospi tal in Taiwan, where highly active antiretroviral therapy (HAART) has been provided to all patients at no charge at any stage of HIV infection since A pril 1, 1997, to describe the spectrum of HIV-associated opportunistic dise ases and evaluate changes of morbidity and mortality from June 24, 1994 thr ough June 23, 1999. Of the patients, 59.3% at study entry had a CD4(+) lymp hocyte count of <50 cells/mu l. The five leading HIV-associated opportunist ic infections included oroesophageal candidiasis (195 patients), Pneumocyst is carinii pneumonia (93), tuberculosis (77), mucocutaneous herpes simplex infection (74), and cytomegalovirus diseases (73). The incidence rates of s even major AIDS-defining opportunistic diseases were declining though the c hanges of the relative proportions varied. The median duration of hospitali zation decreased from 36 days in 1995 to 12 days in 1999 (p = .0001). Overe stimated mortality rate declined from 148.4 per 100 patient-years in 1995 t o 74 per 100 patient-years in 1999 (p = .0001) whereas the underestimated m ortality rate declined from 110.5 to 5.39 per 100 patient-years (p = .0001) . Risk ratio (RR) for mortality in patients who received HAART compared wit h those who did not was 0.410 (95% confidence interval [CT], 0.249-0.674: p = .0004) and the RR was 0.250 (95% CI, 0.127-0.492: p = .0001) when the an alysis was limited to patients with an initial CD4(+) lymphocyte count <100 cells/mu l and follow-up duration >30 days after adjusting for their age, gender, type of risk behavior, and CD4(+) lymphocyte count. Morbidity and m ortality were declining with each study year even in a population consistin g mainly of patients at the advanced stage of HIV infection in Taiwan. Earl ier diagnosis, accumulation of clinical experience, and use of HAART were a ssociated with lower mortality rates.