CHICAGO --- HIV-associated deaths and illnesses recently were reported to be on the decline. This was presumed to be due to improved care, including the availability of new and more potent antiviral drugs and widespread use of viral load testing to better gauge the effectiveness of these therapies. However, precise information as to the extent to which antiviral medication in general, and type of antiviral combination regimens specifically, may have contributed to the observed decrease has been unclear.
An article published in the March 26 issue of the New England Journal of Medicine shows that aggressive combination antiretroviral therapy -- specifically including protease inhibitors -- dramatically reduces death rates and opportunistic infections in HIV-infected patients.
The nationwide study described in the article found that the number HIV-related deaths decreased from almost 30 per 100 person-years in 1994 to about 9 per 100 person-years by mid-1997. At around the same time, prescription rates of combination antiretroviral therapy increased from 25 percent of patients seen in 1994 to 94 percent by June 1997, with dramatic increases noted in prescription of combination regimens including protease inhibitors from 2 percent in mid-1995 to 82 percent by June 1997.
Similarly, incidence of three major opportunistic infections, Pneumocystis carinii pneumonia, Mycobacterium avium complex and cytomegalovirus retinitis, declined from 22 cases per 100 person-years overall in 1994 to 3.7 cases for 100 person years by mid-1997.
"Changing patterns of antiretroviral treatment have reduced the morbidity and mortality of HIV-infected patients," said infectious disease specialist Frank J. Palella, M.D., of Northwestern University Medical School.
"Specifically, combination antiretroviral therapy accounted for the
largest proportion of such reductions," he said.
Contact: Elizabeth Crown