Journal Article

Delayed Progression to Death and to AIDS in a Hong Kong Cohort of Patients with Advanced HIV Type 1 Disease During the Era of Highly Active Antiretroviral Therapy

Ka Hing Wong, Kenny Chi Wai Chan and Shui Shan Lee

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 6, pages 853-860
Published in print September 2004 | ISSN: 1058-4838
Published online September 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/423183
Delayed Progression to Death and to AIDS in a Hong Kong Cohort of Patients with Advanced HIV Type 1 Disease During the Era of Highly Active Antiretroviral Therapy

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Background. The magnitude of the impact of highly active antiretroviral therapy (HAART) since its introduction in non-Western countries is not entirely clear. We studied disease progression among adult patients with advanced human immunodeficiency virus type 1 (HIV-1) infection in the pre-HAART (i.e., 1996 and earlier) and HAART eras in Hong Kong.

Methods. The cohort of patients seen at the Integrated Treatment Center (Hong Kong) from 1984 through mid-2003 was retrospectively examined with respect to 3 clinical end points: death after the diagnosis of acquired immunodeficiency syndrome (AIDS), progression to AIDS after achieving a CD4 cell count of <200 cells/µL, and death after achieving a CD4 cell count of <200 cells/µL.

Results. A total of 581 patients with advanced HIV-1 disease had AIDS and/or a CD4 cell count of <200 cells/µL. The incidences of death after AIDS (52.3% vs. 13.6%), AIDS progression after a CD4 cell count of <200 cells/µL (47.7% vs. 20.9%), and death after a CD4 cell count of <200 cells/µL (38.8% vs. 7.0%) were significantly higher among patients in the pre-HAART era than among those in the HAART era (P < .001 for all). On the basis of life-table analysis, the probabilities of death after AIDS (P < .0001), AIDS after a CD4 cell count of <200 cells/µL (P = .0063), and death after a CD4 cell count of <200 cells/µL (P < .0001) diminished in the HAART era, compared with the pre-HAART era. Median survival after AIDS increased from 29.8 months during the pre-HAART era to >70 months during the HAART era (P < .001). Compared with patients in the pre-HAART era, adjusted hazard ratios of clinical events were 0.15 (95% confidence interval [CI], 0.08–0.26) for death after AIDS, 0.38 (95% CI, 0.24–0.60) for AIDS after a CD4 cell count of <200 cells/µL, and 0.25 (95% CI, 0.15–0.40) for death after a CD4 cell count of <200 cells/µL for patients in the HAART era.

Conclusions. The clinical outcome of patients with advanced HIV-1 disease in Hong Kong significantly improved during the HAART era. Our findings of extended durations of survival and AIDS-free status may be relevant to the expected health impacts associated with increased access to HAART in non-Western countries.

Journal Article.  3686 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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