Causes of the first AIDS‐defining illness and subsequent survival before and after the advent of combined antiretroviral therapy^*

Abstract

ObjectivesTo analyse the impact of combined antiretroviral treatment (cART) on survival with AIDS, according to the nature of the first AIDS-defining clinical illness (ADI); to examine trends in AIDS-defining causes (ADC) and non-AIDS-defining causes (non-ADC) of death. MethodsFrom the French Hospital Database on HIV, we studied trends in the nature of the first ADI and subsequent survival in France during three calendar periods: the pre-cART period (1993-1995; 8027 patients), the early cART period (1998-2000; 3504 patients) and the late cART period (2001-2003; 2936 patients). ResultsThe three most frequent initial ADIs were Pneumocystis carinii (jirovecii) pneumonia (PCP) (15.6%), oesophageal candidiasis (14.3%) and Kaposi's sarcoma (13.9%) in the pre-cART period. In the late cART period, the most frequent ADIs were tuberculosis (22.7%), PCP (19.1%) and oesophageal candidiasis (16.2%). The risk of death after a first ADI fell significantly after the arrival of cART. Lower declines were observed for progressive multifocal leukoencephalopathy, lymphoma and Mycobacterium avium complex infection. After an ADI, the 3-year risk of death from an ADC fell fivefold between the pre-cART and late cART periods (39% vs. 8%), and fell twofold for non-ADCs (17% vs. 9%). ConclusionsThe relative frequencies of initial ADI have changed since the advent of cART. Tuberculosis is now the most frequent initial ADI in France; this is probably the result of the increasing proportion of migrants from sub-Saharan Africa. After a first ADI, cART has a major impact on ADCs and a smaller impact on deaths from other causes. The risk of death from AIDS and from other causes is now similar.

Opportunistic Infections and Mortality: Still Room for Improvement

“…For several opportunistic processes, however, such as central nervous system lymphoma and JC virus encephalitis, survival remains especially poor. These data are in line with reports from other cohorts and jurisdictions [9][10][11][12][13].…”

Human Polyomavirus Receptor Distribution in Brain Parenchyma Contrasts with Receptor Distribution in Kidney and Choroid Plexus

“…18,19 With the advent of combined antiretroviral therapy, the number of HIV/AIDS patients with PML has declined, although it has decreased less significantly than that of other opportunistic infections. 20 While the occurrence of PML historically has been linked to HIV/AIDS, recently the rate of PML has risen again with the introduction of immunomodulatory therapy for autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, psoriasis, and Crohn disease. 21e25 PML has been reported to occur in patients receiving treatment with drugs including the monoclonal antibodies natalizumab, efalizumab, and rituximab.…”

Sarcoma de Kaposi clássico fatal

“…1,6,7 In HIVpositive patients, the introduction of combined, highly active antiretroviral therapy (HAART) resulted in a significant reduction in the number of new cases of epidemic KS from 1996 onwards. [8][9][10] Endemic KS occurs throughout all of equatorial Africa, particularly in sub-Saharan Africa. It affects children and adults, predominantly males, and is not associated with immunodeficiency.…”