Secular trends in opportunistic infections, cancers and mortality in patients with AIDS during the era of modern combination antiretroviral therapy
Author(s) -
Sezgin E,
Van Natta ML,
Thorne JE,
Puhan MA,
Jabs DA
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12609
Subject(s) - medicine , cart , incidence (geometry) , antiretroviral therapy , proportional hazards model , logistic regression , cohort , prospective cohort study , pediatrics , human immunodeficiency virus (hiv) , viral load , immunology , mechanical engineering , physics , optics , engineering
Objectives The aim of the study was to estimate the incidence of, determine risk factors for, and investigate the consequences of opportunistic infections ( OI s) and malignancies among patients with the acquired immune deficiency syndrome ( AIDS ) in the era of modern combination antiretroviral therapy ( cART ). Methods Three enrolment periods (1998–2002, 2003–2005 and 2006–2012), corresponding to changes in predominant cART regimens, were compared among 1889 participants enrolled in a prospective cohort study, the Longitudinal Study of Ocular Complications of AIDS ( LSOCA ). Incidences of AIDS ‐related OI s and cancers were estimated. Multivariate logistic and Cox regression models were used to determine the effect of demographic and clinical characteristics on OI s and mortality. Results Between participants enrolled in the 1998–2002 and 2006–2012 enrolment periods, the incidence of OI s decreased from 27 per 1000 person‐years ( PY ) to 11 per 1000 PY ( P < 0.001), and mortality decreased from 41 per 1000 PY to 18 per 1000 PY ( P < 0.0001), corresponding to improvements in cART regimens. Conclusions Improvements in cART regimens led to a progressive decline in the incidence of OI s and mortality between 1999 and 2013 among patients with AIDS in the era of modern cART .