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Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy.
Clin Infect Dis. 2004 Sep 15; 39(6):853-60.CI

Abstract

BACKGROUND

The magnitude of the impact of highly active antiretroviral therapy (HAART) since its introduction in non-Western countries is not entirely clear. We studied disease progression among adult patients with advanced human immunodeficiency virus type 1 (HIV-1) infection in the pre-HAART (i.e., 1996 and earlier) and HAART eras in Hong Kong.

METHODS

The cohort of patients seen at the Integrated Treatment Center (Hong Kong) from 1984 through mid-2003 was retrospectively examined with respect to 3 clinical end points: death after the diagnosis of acquired immunodeficiency syndrome (AIDS), progression to AIDS after achieving a CD4 cell count of <200 cells/microL, and death after achieving a CD4 cell count of <200 cells/microL.

RESULTS

A total of 581 patients with advanced HIV-1 disease had AIDS and/or a CD4 cell count of <200 cells/microL. The incidences of death after AIDS (52.3% vs. 13.6%), AIDS progression after a CD4 cell count of <200 cells/microL (47.7% vs. 20.9%), and death after a CD4 cell count of <200 cells/microL (38.8% vs. 7.0%) were significantly higher among patients in the pre-HAART era than among those in the HAART era (P<.001 for all). On the basis of life-table analysis, the probabilities of death after AIDS (P<.0001), AIDS after a CD4 cell count of <200 cells/microL (P=.0063), and death after a CD4 cell count of <200 cells/microL (P<.0001) diminished in the HAART era, compared with the pre-HAART era. Median survival after AIDS increased from 29.8 months during the pre-HAART era to >70 months during the HAART era (P<.001). Compared with patients in the pre-HAART era, adjusted hazard ratios of clinical events were 0.15 (95% confidence interval [CI], 0.08-0.26) for death after AIDS, 0.38 (95% CI, 0.24-0.60) for AIDS after a CD4 cell count of <200 cells/microL, and 0.25 (95% CI, 0.15-0.40) for death after a CD4 cell count of <200 cells/microL for patients in the HAART era. CONCLUSIONS. The clinical outcome of patients with advanced HIV-1 disease in Hong Kong significantly improved during the HAART era. Our findings of extended durations of survival and AIDS-free status may be relevant to the expected health impacts associated with increased access to HAART in non-Western countries.

Authors+Show Affiliations

Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong. khwong@dhspp.netNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15472819

Citation

Wong, Ka Hing, et al. "Delayed Progression to Death and to AIDS in a Hong Kong Cohort of Patients With Advanced HIV Type 1 Disease During the Era of Highly Active Antiretroviral Therapy." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 39, no. 6, 2004, pp. 853-60.
Wong KH, Chan KC, Lee SS. Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy. Clin Infect Dis. 2004;39(6):853-60.
Wong, K. H., Chan, K. C., & Lee, S. S. (2004). Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 39(6), 853-60.
Wong KH, Chan KC, Lee SS. Delayed Progression to Death and to AIDS in a Hong Kong Cohort of Patients With Advanced HIV Type 1 Disease During the Era of Highly Active Antiretroviral Therapy. Clin Infect Dis. 2004 Sep 15;39(6):853-60. PubMed PMID: 15472819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy. AU - Wong,Ka Hing, AU - Chan,Kenny Chi Wai, AU - Lee,Shui Shan, Y1 - 2004/08/27/ PY - 2004/03/18/received PY - 2004/04/28/accepted PY - 2004/10/9/pubmed PY - 2005/12/24/medline PY - 2004/10/9/entrez SP - 853 EP - 60 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 39 IS - 6 N2 - BACKGROUND: The magnitude of the impact of highly active antiretroviral therapy (HAART) since its introduction in non-Western countries is not entirely clear. We studied disease progression among adult patients with advanced human immunodeficiency virus type 1 (HIV-1) infection in the pre-HAART (i.e., 1996 and earlier) and HAART eras in Hong Kong. METHODS: The cohort of patients seen at the Integrated Treatment Center (Hong Kong) from 1984 through mid-2003 was retrospectively examined with respect to 3 clinical end points: death after the diagnosis of acquired immunodeficiency syndrome (AIDS), progression to AIDS after achieving a CD4 cell count of <200 cells/microL, and death after achieving a CD4 cell count of <200 cells/microL. RESULTS: A total of 581 patients with advanced HIV-1 disease had AIDS and/or a CD4 cell count of <200 cells/microL. The incidences of death after AIDS (52.3% vs. 13.6%), AIDS progression after a CD4 cell count of <200 cells/microL (47.7% vs. 20.9%), and death after a CD4 cell count of <200 cells/microL (38.8% vs. 7.0%) were significantly higher among patients in the pre-HAART era than among those in the HAART era (P<.001 for all). On the basis of life-table analysis, the probabilities of death after AIDS (P<.0001), AIDS after a CD4 cell count of <200 cells/microL (P=.0063), and death after a CD4 cell count of <200 cells/microL (P<.0001) diminished in the HAART era, compared with the pre-HAART era. Median survival after AIDS increased from 29.8 months during the pre-HAART era to >70 months during the HAART era (P<.001). Compared with patients in the pre-HAART era, adjusted hazard ratios of clinical events were 0.15 (95% confidence interval [CI], 0.08-0.26) for death after AIDS, 0.38 (95% CI, 0.24-0.60) for AIDS after a CD4 cell count of <200 cells/microL, and 0.25 (95% CI, 0.15-0.40) for death after a CD4 cell count of <200 cells/microL for patients in the HAART era. CONCLUSIONS. The clinical outcome of patients with advanced HIV-1 disease in Hong Kong significantly improved during the HAART era. Our findings of extended durations of survival and AIDS-free status may be relevant to the expected health impacts associated with increased access to HAART in non-Western countries. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/15472819/Delayed_progression_to_death_and_to_AIDS_in_a_Hong_Kong_cohort_of_patients_with_advanced_HIV_type_1_disease_during_the_era_of_highly_active_antiretroviral_therapy_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/423183 DB - PRIME DP - Unbound Medicine ER -