ArticlesChanging patterns of mortality across Europe in patients infected with HIV-1
Introduction
AIDS is one of the leading causes of premature death worldwide1, 2, 3, 4, 5 and since the early 1980s such deaths have been steadily increasing in most countries.6 An estimated 30 million or more adults and children had HIV-1 infection or AIDS by the end of 1997, of whom almost 2% were from western Europe. Since the start of the epidemic, more than 11 million people have died. As the number of patients with AIDS continues to increase, future mortality from the disease will increase unless treatment of the disease improves and survival increases.5
Treatment of HIV-1 has changed rapidly since 1994, particularly as a result of combination therapy which reduces the risk of death.7, 8, 9, 10 The most recent class of drugs to be approved are protease inhibitors, which have been shown to increase survival in patients with advanced immunodeficiency.11, 12, 13, 14 Improvements in prophylaxis of opportunistic infections, better access to care, and changes in treatment options may all have contributed to the falling death rates.15, 16, 17, 18
We aimed to find out whether mortality rates had fallen between 1994 and 1998 across Europe in a group of prospectively followed patients infected with HIV-1. We also examined whether the changing mortality rates could be attributed to the introduction of new treatments.
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Patients
The EuroSIDA study is a prospective, pan-European study of patients with HIV-1 in 50 centres across Europe (including Israel). Details of the study have been published elsewhere.19 In brief, centres provided data on consecutive patients seen in the outpatient clinic from May 2, 1994, until a predefined number of patients had been enrolled from each centre. This cohort of 3122 patients is the EuroSIDA I cohort. In December, 1995, a further 1369 patients were enrolled to the EuroSIDA II cohort.
Results
4270 patients with HIV-1 were included in this analysis. Among those who did not die, patients were lost to follow-up at a rate of about 5% per calendar year: the number of patients lost to follow-up was 168 (5·5%) by March, 1996, and 333 (10·9%) by March, 1997. During a median follow-up of 23 months (90% range 2·0–43·1), 1215 (28·5%) patients died. Table 1 shows the characteristics of the patients included in the study and the number of patients who died. The median age at recruitment to
Discussion
Our results show a substantial decrease in mortality associated with HIV-1 across Europe between September, 1995, and March, 1998, in a large cohort of patients. The statistical analyses showed that much of the reduction in mortality could be attributed to treatment changes. In addition, because the first cohort was established in 1994, we have been able to follow both the changes in mortality and the changes in treatment for HIV-1 infection.
There are differences in the recommendations for
References (30)
- et al.
Randomised placebo controlled trial of ritonavir in advanced HIV-1 disease
Lancet
(1998) - et al.
Decline in deaths from AIDS due to new antiretrovirals
Lancet
(1997) - et al.
HIV infection as leading cause of death among young adults in US cities and states
JAMA
(1993) - et al.
Impact of AIDS on mortality in San Francisco, 1979–1986
J Acquir Immune Defic Syndr Hum Retroviral
(1990) - et al.
Impact of AIDS on premature mortality in Amsterdam, 1982–1992
AIDS
(1994) - et al.
Premature mortality related to AIDS among men and women in Catalonia
AIDS
(1993) Excess mortality associated with the HIV epidemic in England and Wales
BMJ
(1991)AIDS-the second decade: a global perspective
J Infect Dis
(1992)Delta: a randomised double-blind trial comparing combinations of zidovudine plus didanosine or zalcitabine with zidovudine alone in HIV-infected individuals
Lancet
(1996)- et al.
A trial comparing nucleoside monotherapy with combination therapy in HIV-infected adults with CD4 cell counts from 0 to 500 per cubic millimetre
N Engl J Med
(1996)
Zidovudine alone or in combination with didanosine or zalcitabine in HIV-infected patients with the acquired immunodeficiency syndrome or fewer than 200 CD4 cells per cubic millimetre
N Engl J Med
Randomised trial of addition of lamivudine or lamivudine plus loviride to zidovudine-containing regimens for patients with HIV-1 infection: CAESAR trial
Lancet
Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy
N Engl J Med
A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeters or less
N Engl J Med
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