Mortality rates of people infected with HIV now approach those of the general population, at least for the first 5 years of the infection, according to a large multinational study.
The gap in mortality rates between people with HIV infection and the general population has narrowed every year since the introduction of highly active antiretroviral therapy in 1996, study investigators reported.
This represents a 94% reduction in excess mortality in recent years, as compared with the time before HAART was available.
However, there still appears to be an excess in mortality as the duration of HIV infection increases.
To compare mortality rates, the investigators used a large data set comprising 21 separate cohorts of HIV-infected subjects whose dates of seroconversion (development of serum antibodies as a result of infection) had been pinned down relatively precisely. These cohorts included 16,534 subjects who were followed for up to 23 years in 10 European countries, Australia, and Canada.
A total of 2,571 of the subjects had died as of the end of 2006, compared with an estimated 235 deaths that would be expected in a matched cohort from the general population. The excess in mortality was most marked during the pre-HAART time period and declined dramatically from 1996 onward, said the investigators, led by Krishnan Bhaskaran of the Medical Research Council Clinical Trials Unit, London.
By the end of the study period in 2006, "there was no evidence of any excess mortality to 5 years from seroconversion in any age group," Mr. Bhaskaran and his associates said (JAMA 2008;300:51-9).
However, some excess mortality was still evident as the duration of HIV infection lengthened to 10 years or more. "It is likely that, even with current standards of HIV management, some long-term excess mortality would remain because problems of toxicity, resistance, and therapy adherence are likely to increase with time," they noted.
Mortality was four times as high among subjects who acquired HIV through intravenous drug use than among those who acquired it through sexual contact. This likely reflects the fact that intravenous drug users are at higher risk than nonusers for mental health-related illness and coinfections, and often have poorer access to and adherence to treatment, the investigators added.