Session 35aOral Abstract Presentations Clinical Trials and Cohorts Session Day and Time: Friday 8:30 - 10:30 am Presentation Time: 09:30 Room: Auditorium
180 Changes in AIDS, Death Rates, and Survival after AIDS in the EuroSIDA Study: 1994- 2002 A. Mocroft*1, B. Ledergerber2, C. Katlama3, O. Kirk4, P. Reiss5, A. d'Arminio Monforte6, B. Knysz7, M. Dietrich8, A. N. Phillips1, J. D. Lundgren4, the EuroSIDA study group 1Royal Free and Univ Coll Med Sch, London, UK; 2Univ Hosp, Zurich, Switzerland; 3Hosp de la Pitie-Saltpetiere, Paris, France; 4Hvidovre Hosp, Denmark; 5Academic Med Ctr, Amsterdam, The Netherlands; 6Hosp L Sacco, Milan, Italy; 7Wroclaw Univ, Poland; and 8Bernhard-Nocht-Inst for Tropical Med, Hamburg, Germany
Background: After the initial decline in AIDS/death rates with the introduction of HAART, information on further changes on a population level is sparse. EuroSIDA, the observational, pan-European study of 8,551 patients (pts) has up to 8 years of follow-up and is ideally placed to document long-term trends in mortality and morbidity.
Methods: Incidence rates of AIDS and/or death were calculated in 6-month periods and in 3 treatment eras (pre-HAART,1994-1995; early-HAART,1996-1997; late- HAART,1998-2002), both overall and according to latest CD4 lymphocyte count. Cox proportional hazards models were used to describe the risk of death according to calendar period and treatment era. Current follow-up is to Spring 2002.
Results: The incidence of AIDS or death declined after September 1998, by 10% per 6-month period (rate ratio (RR) 0.90, 95% CI, 0.86-0.95, p < 0.0001). Considering AIDS and death separately, the incidence of deaths during the late-HAART era was significantly lower than during the early-HAART era among pts whose latest CD4 was 20/mm3 or less (RR 0.47, 95% CI, 0.38-0.58, p < 0.0001) and among pts with a latest CD4 of 21-50/mm3 (RR 0.74, 5% CI 0.55-1.00, p = 0.049). At higher CD4 counts, there was no difference in the incidence of death between early and late HAART. However, the incidence of AIDS was approximately 50% lower in the late-HAART era compared to the pre-HAART era, regardless of the latest CD4 (p < 0.0001, all comparisons). In multivariate Cox models which adjusted for baseline differences and using early-HAART as the reference period, there was a significantly increased risk of AIDS (Relative hazard [RH] 1.25; 95% CI, 1.02-1.51, p = 0.028) or death (RH 1.22; 95% CI, 1.00-1.48, p = 0.048) in the pre-HAART era, and a significantly reduced risk of AIDS (RH 0.66; 95% CI, 0.53-0.83, p = 0.0004) or death (RH 0.69; 95% CI, 0.55-0.86, p = 0.0013) in the late HAART era. Further models showed that changes in CD4 lymphocyte counts explained some of the differences in the risk of death, but not in the risk of AIDS.
Conclusions: There has been a further decline in AIDS and death rates among pts in the EuroSIDA study. Among pts with similar CD4 lymphocyte counts, there was a much lower incidence of AIDS in the late-HAART era compared to early-HAART, but the same pattern was not observed for deaths. As of 2002, the potential long-term adverse effects associated with HAART have not impacted the success of HAART at a population level.
