Correspondence

Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection

N Engl J Med 1998; 339:405-406August 6, 1998

Article

To the Editor:

Palella et al. (March 26 issue)1 reported that the use of more intensive antiretroviral therapies is responsible for declines in both morbidity and mortality in patients with AIDS. We conducted a study to evaluate the impact of protease inhibitors on the rates of selected opportunistic processes and mortality and found similar results.

Our study population came from a public human immunodeficiency virus (HIV) outpatient clinic in New Orleans. All subjects and data were from the Adult Spectrum of Disease study, a prospective study funded by the Centers for Disease Control and Prevention examining the natural history of HIV. The study compared groups of HIV-infected persons with CD4+ cell counts of less than 200 per cubic millimeter assembled 24 months before and 24 months after the availability of protease inhibitors. The groups were initially compared with respect to sex, age at entry into the clinic, race, and mean CD4+ cell count. In addition, the percentage of subjects in the post-availability group for whom a protease inhibitor was prescribed was estimated by choosing a random sample of 100 subjects and abstracting their medical records.

There were 1693 people in the pre-availability group and 1584 in the post-availability group. The pre-availability group had a lower mean CD4+ cell count (92 vs. 98 cells per cubic millimeter, P<0.01). There were no significant differences between the groups with regard to demographic variables. The majority of the subjects in each group were male, 22 to 35 years old at the time of entry into the study, and black. A protease inhibitor was prescribed for an estimated 56 percent of subjects in the post-availability group. The mortality rate was significantly lower in the post-availability group. Among opportunistic processes, the most dramatic decreases were in the rates of Pneumocystis carinii pneumonia, Kaposi's sarcoma, wasting syndrome, Mycobacterium avium complex infection, and cytomegalovirus retinitis (Table 1Table 1Rates of Mortality and Incident Diagnoses of Selected Opportunistic Processes among HIV-Infected Patients 24 Months before and 24 Months after the Availability of Protease Inhibitors.).

Although only an estimated 56 percent of subjects in the post-availability group were treated with protease inhibitors, there were significant decreases in the rates of several opportunistic processes and mortality. In agreement with the results of Palella et al., we found that the introduction of protease inhibitors can have a dramatic effect on the overall morbidity and mortality of a clinic's population.

Stephanie H. Michaels, M.P.H.
Rebecca Clark, M.D., Ph.D.
Patricia Kissinger, Ph.D., R.N.
Louisiana State University School of Medicine, New Orleans, LA 70112

1 References

1. 1

   Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998;338:853-860
   Full Text | Web of Science | Medline

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