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Is HAART Enough? J. WITEK*, L. DEAN, L. EVANGELISTA, and M. GOLD.
MCP Hahnemann Univ., Philadelphia, PA Nationwide, the decline in AIDS-related mortality has been attributed to HAART. However,it is unknown if these benefits extend to all segments of the population and will exert a durable impact on the epidemic. The Partnership Comprehensive Care Practice provides comprehensive outpatient and inpatient services to 1,100 adults in urban Philadelphia. The patient population reflects current epidemic trends: 70% African American, 21% White, 9% Hispanic, 63% male, 37% female, 41% heterosexual and 29% IDU. Care from HIV-experienced providers is rendered at a designated Center of Excellence. Patients have access to all FDA approved drugs, expanded access and other clinical trials. There is an active patient adherence program.
Methods: A retrospective chart review of all deaths occurring in 1998 and the first nine months of 1999 was performed. Abstracted data included immunologic /virologic data, antiretroviral therapies, OI's/cause of death. Supplemental data was obtained through a practice database maintained since 1994.
Results: There were 40 deaths (25 male and 15 female) during the time period examined; 18 in 1998 and 22 from January through September, 1999. Compared to those who died in 1998, patients who died in 1999 presented for care sooner after diagnosis (1 vs 14 mo., p=0.045), and had higher initial (250 vs 36.5, p=0.022) CD4 counts. Patients who died in 1999 had: lower viral loads on presentation to care (66,500 vs 189,500); longer time in care (45 vs 24 mo.); and higher final CD4 counts (67 vs 26.5). Those who died in 1999 had taken more antiretroviral regimens (3 vs 2), had better adherence, and appeared more likely to have ever had a virologic response to HAART (59% vs 16%). 11 out of 40 patients died with viral loads less than 5,000 copies, 7 of whom had viral loads less than 400 copies. Patients who died in 1999 were less likely to have used illicit drugs within 6 months of their deaths. The 3 most common causes of death for both years were wasting syndrome, complications related to hepatitis C infection, and mycobacterial disease.
Conclusion: Among an urban population representative of today's epidemic, mortality continues to be significant even with early access to HIV care and HAART. Further research is needed to develop additional interventions that will impact the mortality associated with this disease across a broad range of populations.
Key Words: Epidemiology, HAART, Mortality
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