341   Long-Term Survival After Initiation of Antiretroviral Therapy.

R. Chen*, A. Westfall, G. Cloud, A. Chatham, E. Acosta, J. Raper, G. Heudebert, and M. Saag.
Univ. of Alabama at Birmingham.

Background:The optimal time of initiation of antiretroviral therapy remains in flux. Long-term outcome data, especially survival data, are needed.

Methods:HIV pts were drawn from a prospective cohort at UAB and were included if they initiated their first HAART regimen after 1/96. Survival outcome was determined for all patients, segregated by their initial CD4 count at the time of Rx initiation. Kaplan-Meier analyses with associated log rank tests were used to assess correlations between independent factors and mortality.

Results:715 pts (78% M, 56% W, 37 yrs) met eligibility criteria. Median F/U = 3 years; 80 pts (8.9%) died. KM survival analyses, stratified by CD4 count, shows:

Having a CD4 count <200 (p = 0.0001), a VL >50,000 (p = 0.0002), and a prior OI (p < 0.0001) at the time of starting HAART Rx were associated with higher mortality. Race, age, gender, ART Rx (and duration) prior to HAART, use of a PI in HAART Rx, and number of regimens before or after first HAART Rx were not associated with survival.

Conclusions:Individuals who received HAART Rx 'later' in the course of disease had a significant chance of death within 4 years after starting therapy. While these data do not directly determine the optimal time of Rx initiation, it appears best to start therapy prior to the development of moderately advanced disease.