Individuals diagnosed with AIDS in 1991 have nearly twice the survival time of those diagnosed in 1984 because of improved therapies and health care, according to results from an ongoing study by the National Institute of Allergy and Infectious Diseases (NIAID). The study results are scheduled for presentation June 8 at the IX International Conference of AIDS in Berlin.
In addition to the positive impact of anti-HIV drugs, the progress in increasing survival after diagnosis has been helped by the recent advances in the prevention and treatment of opportunistic infections affecting people with AIDS," says Lisa P. Jacobson, Sc. M., MACS Data Coordinating Center at The Johns Hopkins School of Public Health in Baltimore, Md.
The findings come from the NIAID-supported Multicenter AIDS Cohort Study (MACS), which has followed more than 5,000 gay and bisexual men with HIV or at risk of infection since 1984. The men live in the metropolitan areas of Baltimore, Chicago, Los Angeles and Pittsburgh.
While a good proportion of the MACS men diagnosed with AIDS in 1990 or 1991 survived for nearly two years after their diagnosis, this improvement in survival was not uniform for all of AIDS-defining illnesses seen in MACS," says Lewis K. Schrager, M.D., chief of the epidemiology section of the Vaccine Trials and Epidemiology Branch of NIAID's Division of AIDS and project officer for MACS. "However, it will be important to see if the apparent slowing of the increase seen since 1988 continues into the future."
For men diagnosed with AIDS in 1984 to 1985, 50 percent had survival times of less than 11.6 months. At any given time, MACS participants diagnosed with AIDS since 1988 have half the risk of dying compared to those earlier cases, demonstrating that AIDS survival time has significantly improved since 1984, Ms. Jacobson says.
The greatest gain in survival time occurred among the MACS participants whose AIDS-defining illness was Pneumocystis carinii pneumonia (PCP), which is the most common opportunistic infection (OI) among AIDS patients in general, says Ms. Jacobson.
Survival time after an AIDS diagnosis among MACS participants developing PCP increased from a median of 12.8 months in 1984 to 1985 to a median of 26.3 months in 1990 to 1991.
In comparison, the likelihood of dying among MACS men with fewer than 100 CD4+ T cells per cubic millimeter of blood (mm3) who develop Kaposi's sarcoma (KS), an AIDS-related cancer, decreased by almost two-thirds from 1984 to 1989. However, MACS men who had more than 100 CD4+ T cells when diagnosed with KS did not have significant changes in their survival times.
HIV targets and kills CD4+ T cells, which are crucial to the immune system. A healthy adult has 800 to 1,200 such cells.
Survival times after developing other OIs for those whose immune systems were not greatly suppressed at the time of diagnosis consistently improved, but the increase was not significant. This improvement may reflect the use of effective OI therapies, but further strides need to be made, explains Ms. Jacobson. Survival for those who were more immunosuppressed did not improve. Neither age at diagnosis nor study center significantly affected participants' survival times.
MACS study sites include The Johns Hopkins University in Baltimore, Md., Northwestern University in Chicago, Ill., University of California at Los Angeles and the University of Pittsburgh, Pa. Dr. Jacobson's coauthors for the study presented in Berlin include Jill Kirby, Ph.D., Sarah Polk, John P. Phair, M.D, David R. Besley, M.D., and Alfred J. Saah, M.D.
NIAID, a component of the National Institutes of Health, supports investigators and scientific studies at universities, medical schools, hospitals and research institutions in the United States and abroad aimed at preventing, diagnosing and treating such illnesses as AIDS, tuberculosis, allergies, and asthma. NIH is an agency of the U.S. Public Health Service, part of the U.S. Department of Health and Human Services.
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