Objective: To characterize the effect of widespread availability of protease inhibitors (PI) on survival of Maryland AIDS cases.
Methods: Adult cases (age 20+) diagnosed 1/94-6/96 (pre-PI) were followed through 6/96 and those diagnosed 7/96-12/98 (post-PI) were followed through 12/98. Results: The pre-PI group (N=5420) experienced 1435 deaths (26.5%) while the post-PI group (N=3629) experienced 567 deaths (15.6%). Based on Kaplan-Meier estimates, survival time from AIDS diagnosis increased significantly for the post-PI group [RH=.53 (.48, .59); Log-Rank p<.0001]. In the Cox multivariate model, increased post-PI survival remains significant [RH=.54 (.49, .60); p<.0001] after controlling for demographic and clinical factors. Higher mortality is significantly associated with advancing age RH=1.88, male gender RH=1.15, diagnosis by an OI (opportunistic infection) versus a CD4+ count <200 cells/ul RH=1.98, and a primary diagnosis of multiple OI’s, RH=2.12. Diagnosis in a state prison had a protective effect on survival, RH=.45 along with reported modes of exposure of MSM, MSM/IDU, and heterosexual contact [RH=.76, .69, .81]. Elderly cases (age 60+) had substantially reduced survival times than the non-elderly (20-59) (36.3% versus 61.6% two-year survival pre-PI) and benefited less from the era of PI’s, (57.5% versus 80.4% two-year survival post-PI).
Conclusions: Survival time following an AIDS diagnosis is significantly longer after the widespread introduction of protease inhibitors in July 1996. Not all groups may be benefiting equally from PI’s as demonstrated with elderly cases. Limitations include the inability to assess actual use of treatment and to adjust for comorbidities and delays in care, particularly among the elderly.
Learning Objectives: 1) To characterize the survival of Maryland resident AIDS cases. 2)To identify differences in survival in different subpopulations. 3)To identify risk factors that act as potential confounders or effect modifiers on the association between survival and treatment era groups
Keywords: HIV/AIDS, Antiretroviral Combination Therapy
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.