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. 2015 Nov 1;212(9):1366-75.
doi: 10.1093/infdis/jiv235. Epub 2015 Jun 3.

Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012

Kpandja Djawe  1 , Kate Buchacz  2 , Ling Hsu  3 , Miao-Jung Chen  3 , Richard M Selik  2 , Charles Rose  2 , Tiffany Williams  4 , John T Brooks  2 , Sandra Schwarcz  5
Affiliations

Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012

Kpandja Djawe et al. J Infect Dis. .

Abstract

Objective: To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI.

Design: We used HIV surveillance data to conduct a survival analysis.

Methods: We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012.

Results: Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17).

Conclusions: Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.

Keywords: AIDS; AIDS-defining illness; HIV; mortality; survival.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts of interest.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Overall survival time after diagnosis of the first AIDS-defining opportunistic illness (AIDS-OI) by human immunodeficiency virus (HIV) treatment era (1: pre– [ART], 1981–1986; 2: mono/dual ART, 1987–1996; and 3: combination ART [cART], 1997–2012) in San Francisco, 1981–2012. Abbreviation: ART, antiretroviral therapy.
Figure 2.
Figure 2.
Survival time after diagnosis of the first AIDS-defining opportunistic illness (AIDS-OI) by human immunodeficiency virus (HIV) treatment era (1: pre– [ART], 1981–1986; 2: mono/dual ART, 1987–1996; and 3: combination ART [cART], 1997–2012) for persons with the ten most common AIDS-OIs in San Francisco, 1981–2012. Abbreviation: ART, antiretroviral therapy.
Figure 2.
Figure 2.
Survival time after diagnosis of the first AIDS-defining opportunistic illness (AIDS-OI) by human immunodeficiency virus (HIV) treatment era (1: pre– [ART], 1981–1986; 2: mono/dual ART, 1987–1996; and 3: combination ART [cART], 1997–2012) for persons with the ten most common AIDS-OIs in San Francisco, 1981–2012. Abbreviation: ART, antiretroviral therapy.
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