Combined Antiretroviral Therapy Has Halved Mortality in HIV Patients Since 1996
NEW YORK (Reuters Health) :Combined antiretroviral therapy appears to have cut the average mortality rate by half in HIV patients followed for an average of more than three years, researchers report in the January 2nd issue of AIDS.
In absolute terms, say the investigators, “this mortality reduction was translated into a 5% increase in 5-year survival for (combined therapy) initiation compared with no initiation.”
Dr. Miguel A. Hernan, of the Harvard School of Public Health, Boston, and colleagues note that the introduction of combined therapy in 1996 has greatly improved surrogate markers such as CD4 cell count and HIV RNA levels among patients in the developed world. The impact on overall mortality, however, remained unclear.
To test whether combined therapy was actually saving lives, the team examined data from 12 European and US prospective studies involving 62,760 previously therapy-naive HIV patients who were followed for an average of 3.3 years.
There were 2039 deaths during follow-up. After adjustment, the hazard ratio in those who had started combined therapy was 0.48 compared to those who had not.
The CD4 cell count at baseline appeared to influence the amount of benefit seen with combined antiretroviral therapy. In subjects with counts less than 100 cells/microliter, therapy cut the risk of death by 71%, whereas in those with counts of 500 cells/microliter or higher, therapy reduced the risk by only 23%.
The estimated hazard ratio also varied with years since initiation of combined therapy, ranging from 0.57 for less than 1 year since initiation to 0.21 for 5 years or more.
Combined therapy, the authors note, “halved the mortality rate of HIV-infected individuals in developed countries, and…the absolute reduction in mortality was stronger in those with worse prognosis at the start of follow-up.”
The finding, the team concludes, “demonstrates the benefits of being treated even at the most advanced stages of immunosuppression.”