TUESDAY, July 1 (HealthDay News) -- Death rates for HIV-infected
people lucky enough to get their hands on antiretroviral
medications have decreased dramatically since the introduction of
these drugs in 1996, new British research shows.
For most, the five-year, post-diagnosis survival for those
infected sexually is now about equal to that of the general
population.
Death rates were higher, however, for older individuals, for
those who had been infected for a longer time, and for those who
had been infected through intravenous drug use.
Dramatic declines in death rates for HIV-infected individuals
following the introduction of highly active antiretroviral therapy
(HAART) in industrialized nations in the mid-90s have already been
documented.
"HIV is now a complex chronic disease," said Dr. Michael
Horberg, director of HIV/AIDS at Kaiser Permanente Health Plan in
Santa Clara, Calif. "And, if aggressively treated with accepted
medications, we should expect to see mortality similar to the
general population in that same demographic."
"[This information] will help health policy makers or those who
monitor the effectiveness of treatments to forecast the impact of
AIDS on health-care needs," said Srikanth Kolluru, an assistant
professor of pharmaceutical sciences with the Texas A&M Health
Science Center in Kingsville. "One important thing to know is that
the composition of HAART regimen will keep changing for a
particular patient during his/her course of therapy depending on
the development of tolerance to the particular drug. Hence, newer
drugs with different mechanisms of action are continuously needed
to be added to HAART regimen to maintain the low mortality
rate."
The authors of the current study, published in the July 2 issue
of the
Journal of the American Medical Association, updates
existing information, deliberately focusing on people whose
seroconversion rates were relatively well-established.
Seroconversion refers to the time when antibodies to HIV appear in
the blood, usually from one week to several months or more after
actual infection.
More than 16,000 individuals in multiple countries were followed
for a median of 6.3 years. During the follow-up period, 2,571
individuals with HIV infection died compared with 235 who would be
expected to die in an equivalent general population.
The excess mortality rate decreased from 40.8 per 1,000
person-years before the introduction of HAART to 6.1 per 1,000
person-years in the 2004 to 2006 period.
There was essentially no excess mortality in the first five
years after seroconversion among individuals who had been infected
sexually. However, over the first 10 years, those aged 15 to 24
years old and those 45 years or over at seroconversion did have
higher death rates.
The authors calculated an 88 percent reduction in excess
mortality in 2000-2001 compared with the period prior to 1996. This
was very close to the 87 percent reduction seen in 1997-2001. In
2004-2006, the excess mortality was 94 percent lower than pre-1996
levels.
The study did not take into account adherence to medication or
side effects, which can be severe.
"The study doesn't take into account adverse events and
medication adherence. And, over a longer time frame, we don't know
if there might be an effect from medications accumulating in the
body," Horberg said.
"Despite all these side effects [including diarrhea, nausea,
vomiting, fat redistribution], HAART therapy still improves the
quality of life and life expectancy, which is nearing close to that
of uninfected population," Kolluru said. "Prevention is still the
best treatment for AIDS, and that has no side effects."
More information
The
U.S. Centers for
Disease Control and Prevention have more on HIV/AIDS.
