Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators

BACKGROUND & METHODS: National surveillance data show recent, marked reductions in morbidity and mortality associated with the acquired immunodeficiency syndrome (AIDS). To evaluate these declines, we analyzed data on 1255 patients, each of whom had at least one CD4+ count below 100 cells/mm' who were seen at 9 clinics specializing in the treatment of human immunodeficiency virus (HIV) infection in 8 U.S. cities from January 1994 through June 1997. RESULTS: Mortality among the patients declined from 29.4/100 person-yrs in the first quarter of 1995 to 8.8/100 in the second quarter of 1997. There were reductions in mortality regardless of sex, race, age, and risk factors for transmission of HIV. The incidence of any of 3 major opportunistic infections (Pneumocystis curinii pneumonia, Mycohacterium avium complex disease, and cytomegalovirus retinitis) declined from 21.9 /100 person-yrs in 1994 to 3.7/100 person-yrs 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 inhibitor) were associated with stepwise reductions in morbidity and mortality. Combination antiretroviral therapy was associated with the most benefit; the inclusion of protease inhibitors in such regimens conferred additional benefit. Patients with private insurance were more often prescribed protease inhibitors and had lower mortality rates than those insured by Medicare or Medicaid. CONCLUSIONS: The recent declines in morbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies.