Nj. Ives et al., The changing pattern of AIDS-defining illnesses with the introduction of highly active antiretroviral therapy (HAART) in a London clinic, J INFECTION, 42(2), 2001, pp. 134-139
Objectives: To quantify the progressive impact of combination antiretrovira
l therapy (ART) on the incidence of AIDS-defining illnesses (ADIs) over a 9
-year period.
Methods: Retrospective cohort study. Eligible patients were 1538 AIDS-free,
HIV-l-positive patients attending a large HIV clinic in west London who we
re at risk of developing AIDS because their CD4 count had declined to less
than or equal to 350 x 10(6)/1 cells during the period 1 January 1990 and 3
1 December 1998, Incidence rates for the 12 most frequent ADIs were compare
d for two time periods, 1990-1995 (pre-HAART) and 1996-1998 (post-HAART), u
sing Poisson regression methods. Multivariate Poisson regression models wer
e used to examine the contribution of ART and HAART to any observed tempora
l trends in incidence rates.
Results: After a median follow-up of 35 months, 450 (29%) patients had deve
loped AIDS. Between the two time periods there was a significant decrease i
n the incidence of Pneumocystis carinii pneumonia (PCP) by 35% (4.11 per 10
0 person-years in 1990-1995 vs. 2.67 in 1996-1998: P = 0.007), Kaposi's sar
coma by 34% (3.27 vs. 2.17; P = 0.022) and cryptosporidiosis by 60% (0.76 v
s. 0.31; P = 0.029). A non-significant reduction in incidence was observed
for cryptococcosis by 45% (0.81 vs. 0.45: P = 0.11), oesophageal candidiasi
s by 29% (3.34 vs. 2.39; P = 0.053) and mycobacterium avium complex by 18%
(1.58 vs. 1.29; P = 0.4), and a non-significant increase was observed for t
uberculosis by 17%, (0.62 vs. 0.73: P = 0.66) and non-Hodgkins lymphoma (NH
L) by 51% (0.43 vs. 0.65: P = 0.31). The incidence of cerebral toxoplasmosi
s, cytomegalovirus, recurrent bacterial chest infections and dementia remai
ned stable. There was a clear stepwise reduction in the incidence of PCP, K
aposi's sarcoma and cryptosporidiosis with the use of non-HAART and HAART r
egimens relative to no ART. In a multivariate analysis, the use of ART and
HAART explained the progressive decrease in incidence of PCP and Kaposi's s
arcoma,
Conclusions: The incidence of most ADIs has decreased over the last 9 years
. The striking reduction in the incidence of PCP and Kaposi's sarcoma since
1996 can be attributed to the use of combination ART and particularly HAAR
T, The non-significant increase in the incidence of NHL and tuberculosis ne
eds confirmation in other patient cohorts. (C) 2001 The British Infection S
ociety.