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

Details

• Alternative Title:
  J Infect Dis
• Personal Author:
  Djawe, Kpandja ; Buchacz, Kate ; Hsu, Ling ; Chen, Miao-Jung ; Selik, Richard M. ; Rose, Charles ; Williams, Tiffany ; Brooks, John T. ; Schwarcz, Sandra
• Description:
  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.
  
  
• Subjects:
  Acquired Immunodeficiency Syndrome Adolescent Adult AIDS-Related Opportunistic Infections Antiretroviral Therapy, Highly Active Female Follow-Up Studies HIV Infections Humans Leukoencephalopathies Male Middle Aged Pneumonia, Pneumocystis Proportional Hazards Models Risk Factors San Francisco Sarcoma, Kaposi Survival Analysis Young Adult

  More +
• Keywords:
  AIDS AIDS-defining Illness HIV Mortality Survival
• Source:
  J Infect Dis. 212(9):1366-1375
• Pubmed ID:
  26044289
• Pubmed Central ID:
  PMC11323282
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  212
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:e8e4af9cdb89a019477233dd6995af5f69c231dde570862ec2b104b2908e2c0fe09c90bf8fe33da391ab2a0834ac13ee406b11e1e60f2b767f02148f91891775
• Download URL:
  https://stacks.cdc.gov/view/cdc/160151/cdc_160151_DS1.pdf
• File Type:
  [PDF - 678.05 KB ]