Effect of comprehensive intervention program on survival of patients with human immunodeficiency virus infection

Abstract

Background: In October 1989, an early intervention program (EIP) for human immunodeficiency virus (HIV) infection was initiated in New Jersey to provide medical care and social services to the enrollees.

Objective: To assess the overall effect of the EIP on the survival of HIV-infected patients.

Methods: Patient information collected through June 30, 1993, was analyzed from the Jersey City Medical Center EIP clinic. Survival from enrollment to death was calculated for patients who received follow-up at the clinic (active) and for those who only had the enrollment visit (inactive). The data were matched with the New Jersey death certificate registry.

Results: Of 938 patients enrolled from October 1989 to December 1991, 767 had T-cell subsets determined within 3 months of enrollment: 641 patients were active and 126 were inactive. At entry, inactive patients had a lower median CD4+ T-cell count and were more likely to be symptomatic than active patients. Among the 640 active and 125 inactive patients analyzed for survival (survivors > or = 2 months), there were 144 (22.5%) and 48 (38.4%) deaths, respectively. Kaplan-Meier analysis indicated longer survival for active patients than for inactive patients (P < .001, Wilcoxon's test for homogeneity of strata); eg, survival probability at 2 years was 86% for active patients and 64% for inactive patients. Active patients also had longer survival than inactive patients when stratified by CD4+ T-cell levels or by clinical status. Only active and inactive patients with both CD4+ T-cell levels lower than 0.20 x 10(9)/L (< 200/microL) and symptoms of HIV or acquired immunodeficiency syndrome had similar survival rates. Survival was not influenced by sex, race, or HIV transmission category.

Conclusion: Participation in the EIP was associated with longer survival of HIV-infected patients.