*This work was presented in part as a poster at the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, CA, February 2007.
Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy*
Article first published online: 23 MAR 2008
© 2008 British HIV Association
Volume 9, Issue 4, pages 246–256, April 2008
How to Cite
Grabar, S., Lanoy, E., Allavena, C., Mary-Krause, M., Bentata, M., Fischer, P., Mahamat, A., Rabaud, C., Costagliola, D. and on behalf of the Clinical Epidemiology Group of the French Hospital Database on HIV (2008), Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy. HIV Medicine, 9: 246–256. doi: 10.1111/j.1468-1293.2008.00554.x
- Issue published online: 23 MAR 2008
- Article first published online: 23 MAR 2008
- Received: 12 September 2007, accepted 17 January 2008
- AIDS-defining illness;
- cause of death;
- cohort study;
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.