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J Infect Dis. 2015 Nov 1;212(9):1366-75. doi: 10.1093/infdis/jiv235. Epub 2015 Jun 3.

Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012.

Author information

1
Division of HIV/AIDS Prevention Epidemic Intelligence Service Program.
2
Division of HIV/AIDS Prevention.
3
HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health.
4
Division of HIV/AIDS Prevention ICF International, Assigned Full-time to Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia.
5
HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health Department of Epidemiology and Biostatistics, University of California San Francisco.

Abstract

OBJECTIVE:

To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI.

DESIGN:

We used HIV surveillance data to conduct a survival analysis.

METHODS:

We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012.

RESULTS:

Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17).

CONCLUSIONS:

Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.

KEYWORDS:

AIDS; AIDS-defining illness; HIV; mortality; survival

PMID:
26044289
DOI:
10.1093/infdis/jiv235
[Indexed for MEDLINE]

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