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Determinants of survival following HIV-1 seroconversion after the introduction of HAART.

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Title: Determinants of survival following HIV-1 seroconversion after the introduction of HAART.
Authors: CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) Collaboration (CORPORATE AUTHOR), Porter, Kholoud (AUTHOR), Babiker, Abdel (AUTHOR), Bhaskaran, Krishnan (AUTHOR), Darbyshire, Janet (AUTHOR), Pezzotti, Patrizio (AUTHOR), Walker, A Sarah (AUTHOR), CASCADE Collaboration (CORPORATE AUTHOR)
Source: Lancet. 10/18/2003, Vol. 362 Issue 9392, p1267-1274. 8p.
Abstract: Background: Highly active antiretroviral therapy (HAART) was introduced in 1997. We aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion.Methods: We used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted. Retrospective and prospective data were used. We compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).Findings: Of 7740 seroconverters, 2000 (26%) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 0.47 [95% CI 0.39-0.56] in 1997, dropping further to 0.16 [0.12-0.22] in 2001. Correspondingly, the proportion of person-time on HAART increased from 22% in 1997 to 57% in 2001. By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men (HR 4.28 [2.86-6.41]). However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years (2.03 [1.67-2.47]), in 1999-2001 there was little evidence of a difference in risk by age (HR=1.17 [0.60-2.30]; interaction p=0.06). No such attenuation in the effect of age on survival was observed (p=0.63).Interpretation: Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART; however, the importance of age and exposure category as determinants of progression seems to have changed. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Determinants of survival following HIV-1 seroconversion after the introduction of HAART.
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  Data: <searchLink fieldCode="AR" term="%22CASCADE+%28Concerted+Action+on+SeroConversion+to+AIDS+and+Death+in+Europe%29+Collaboration%22">CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) Collaboration</searchLink> (CORPORATE AUTHOR)<br /><searchLink fieldCode="AR" term="%22Porter%2C+Kholoud%22">Porter, Kholoud</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Babiker%2C+Abdel%22">Babiker, Abdel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bhaskaran%2C+Krishnan%22">Bhaskaran, Krishnan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Darbyshire%2C+Janet%22">Darbyshire, Janet</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pezzotti%2C+Patrizio%22">Pezzotti, Patrizio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Walker%2C+A+Sarah%22">Walker, A Sarah</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22CASCADE+Collaboration%22">CASCADE Collaboration</searchLink> (CORPORATE AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 10/18/2003, Vol. 362 Issue 9392, p1267-1274. 8p.
– Name: Abstract
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  Data: <bold>Background: </bold>Highly active antiretroviral therapy (HAART) was introduced in 1997. We aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion.<bold>Methods: </bold>We used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted. Retrospective and prospective data were used. We compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).<bold>Findings: </bold>Of 7740 seroconverters, 2000 (26%) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 0.47 [95% CI 0.39-0.56] in 1997, dropping further to 0.16 [0.12-0.22] in 2001. Correspondingly, the proportion of person-time on HAART increased from 22% in 1997 to 57% in 2001. By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men (HR 4.28 [2.86-6.41]). However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years (2.03 [1.67-2.47]), in 1999-2001 there was little evidence of a difference in risk by age (HR=1.17 [0.60-2.30]; interaction p=0.06). No such attenuation in the effect of age on survival was observed (p=0.63).<bold>Interpretation: </bold>Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART; however, the importance of age and exposure category as determinants of progression seems to have changed. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: 10/18/2003
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