Highly active antiretroviral therapy was introduced around 1996 and immediately brought about a substantial reduction in illness and death for people with HIV-1 infection. Amanda Mocroft from The Royal Free and University College Medical School, London, UK, and colleagues investigated whether the short-term benefits of HAART have been sustained by prospectively analysing around 9800 patients with HIV/AIDS across 70 centres in Europe, Israel, and Argentina.
The investigators calculated rates of AIDS and death in relation to patients' CD4 counts (the immune cells which target HIV infection) over three time frames: Pre-HAART (1994-95), early HAART (1996-97), and late HAART (1998-2002).
The incidence of AIDS or death fell by 8% every six months after September 1998. Patients with low CD4 counts (often an indicator of a poor prognosis) had much better survival rates in the late-HAART period than in the years immediately after HAART was introduced. The incidence of AIDS was about 50% lower in late-HAART than in early-HAART; the risk of all deaths was reduced by around 40% in the late-HAART compared with the early-HAART years.
Amanda Mocroft comments: "The introduction and continued use of HAART over the past 6 years has resulted in very low morbidity and mortality rates across Europe, suggesting that limitations of current treatment, including potential adverse effects of long-term HAART and problems with compliance, have not yet affected the clinical success of HAART in the population. Long-term follow-up of large cohorts such as those in this study should prove essential to observe changing causes of morbidity and mortality among patients with HIV."
Contact:
Dr Amanda Mocroft, Royal Free Centre for HIV Medicine, Department of Primary Care and Population Studies, Royal Free and University College Medical School, Royal Free Campus.Rowland Hill Street, London NW3 2PF; T) 44-0-20-7830-2239; F) 44-0-20-7794 1224; E) a.mocroft@pcps.ucl.ac.uk
Journal
The Lancet