Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy


  • *This work was presented in part as a poster at the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, CA, February 2007.

Dr S Grabar, Hôpital Cochin, Biostatistique et Informatique Médicale, Unité de Biostatistique et d'Epidémiologie Clinique, 27 Rue du Fg St Jacques, 75 679 Paris Cedex 14, France. Tel:+33 1 5841 2024 (direct line)/+33 1 5841 3154 (secretary); fax:+33 1 5841 1961; e-mail:



To analyse the impact of combined antiretroviral treatment (cART) on survival with AIDS, according to the nature of the first AIDS-defining clinical illness (ADI); to examine trends in AIDS-defining causes (ADC) and non-AIDS-defining causes (non-ADC) of death.


From the French Hospital Database on HIV, we studied trends in the nature of the first ADI and subsequent survival in France during three calendar periods: the pre-cART period (1993–1995; 8027 patients), the early cART period (1998–2000; 3504 patients) and the late cART period (2001–2003; 2936 patients).


The three most frequent initial ADIs were Pneumocystis carinii (jirovecii) pneumonia (PCP) (15.6%), oesophageal candidiasis (14.3%) and Kaposi's sarcoma (13.9%) in the pre-cART period. In the late cART period, the most frequent ADIs were tuberculosis (22.7%), PCP (19.1%) and oesophageal candidiasis (16.2%). The risk of death after a first ADI fell significantly after the arrival of cART. Lower declines were observed for progressive multifocal leukoencephalopathy, lymphoma and Mycobacterium avium complex infection. After an ADI, the 3-year risk of death from an ADC fell fivefold between the pre-cART and late cART periods (39%vs. 8%), and fell twofold for non-ADCs (17%vs. 9%).


The relative frequencies of initial ADI have changed since the advent of cART. Tuberculosis is now the most frequent initial ADI in France; this is probably the result of the increasing proportion of migrants from sub-Saharan Africa. After a first ADI, cART has a major impact on ADCs and a smaller impact on deaths from other causes. The risk of death from AIDS and from other causes is now similar.