People infected with HIV are still at risk of death from opportunistic diseases despite dramatic gains in survival
The risk of death due to Opportunistic Infections (IO)* has decreased dramatically since the advent of combination antiretroviral therapy (ART) (cocktail, as some say) in the mid-90 decade, but even in the effective ART era about one-third of people diagnosed with a first IO died within 5 years, according to the analysis of more than 20.000 people living with HIV in San Francisco.
Untreated HIV infection normally leads to severe immune dysfunction within a few years, leaving people susceptible to opportunistic infections and cancers that could normally be kept under control by a healthy immune system.
It is well known that HAART development led to a sharp decline in the occurrence of OIs and a general decline in mortality among people living with HIV / AIDS. Previous study showed that the incidence of AIDS-defining illnesses (IOs) in San Francisco decreased approximately 99% from 1993 to 2008. However, the effect of the specific stabilizer on death rates has not been fully described.
As reported in early edition of the report official infectious disease in 3 In June, Kpandja Djawe of the Centers for Disease Control and Prevention and colleagues examined the question of whether better treatment of HIV infection was associated with improved survival after the diagnosis of AIDS-defining diseases, opportunistic diseases , and how survival would differ.
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The researchers searched data collected by the San Francisco Public Health Department of 20.858 adult persons with AIDS in the city from 1981. Most were gay men, white, with an average age of about 40 years, but over time demographics shifted more to blacks and Hispanics / Latinos among men and women who contracted HIV through use injecting drug use or transmission among heterosexual people.
They calculate survival probabilities after a first AIDS-defining illness, an IO, and post-diagnostic treatment during 3: 1981-1986 (no effective treatment), 1987-1996 (NRTI monotherapy or dual therapy only), and 1997 -2012 (multi-class effective combination TARV). Data included 3002 persons diagnosed during the first period, 14.097 diagnosed during the second period, and 3759 who were diagnosed during the third period.
- A total of 17.099 people infected with HIV died during the observation period, including 2957 during the first period (98%), 12.569 during the second period (89%), and 1573 - during the third period (42%).
- After adjusting for error factors, the average probability of 5 years of survival among people diagnosed with AIDS (IOS) increased from 7% in 1981-1986 to 18% in 1987-1996 and to 65% during the period between 1997 -2012.
- Put another way, mortality rates in a period of 5 years decreased from 93% to 82% to 35%, respectively.
- The highest survival was observed in the gain refers to the deaths related to pneumocystose, going from only 1% during the first period to 69% during the third period.
- The most common AIDS-defining diseases were Pneumocystis pneumonia (8163 cases), Kaposi's sarcoma (4195 cases), wasting syndrome (1864 cases), esophageal candidiasis (1381 cases), Mycobacterium avium complex (1.069 cases), Bovine spongiform encephalopathy related to HIV (932 cases), the extrapulmonary cryptococcosis (883 cases), cryptosporidiosis (694 cases), immunoblastic lymphoma (676 cases), and the disease by cytomegalovirus, excluding CMV retinitis (643 cases).
- The five AIDS-defining diseases, IOs, less frequent were isosporiasis (36 cases), disseminated coccidioidomycosis (32 cases), recurrent sepsis Salmonella (19 cases), and invasive cervical cancer (12 cases).
- During 1997-2012, adjusted mortality rates were higher for cerebral lymphoma (note from the editor of Soropositivo.Org; I lost a friend like this) e progressive multifocal leukoencephalopathy.
One limitation of this analysis is that the combination of the ART era is quite long and substantial changes in treatment have been seen. Early regimens were more difficult to take, had the worst side effects, and did not control HIV replication like modern regimens, especially for people with antiretroviral drug resistance. Subdividing this time period may show that current OI and current mortality rates are lower than in the mid-1990 and early 2000 years.
"Survival after the diagnosis of the first AIDS-defining Opportunistic Infection has improved significantly since 1981," the study authors concluded. "Some AIDS-defining illnesses remain associated with a higher mortality risk more substantially than others, even after adjusting for known errors. Better prevention and treatment strategies are still needed to prevent the occurrence of AIDS-defining illnesses in the current era of HIV treatment. "
"While recent research suggests that many opportunistic infections in the US are now less common and often less lethal, we can not forget them," Djawe said in a statement. Press release Issued by the American Society of Infectious Diseases.
"We have to keep them in mind, even in the context of the evolution of HIV epidemiology."
"Better prevention and treatment strategies, including the early diagnosis of HIV positive serology, are needed to reduce the heavy burden of AIDS with opportunistic infections, even today, in the age of combining antiretroviral therapy," added co-author Sandra Schwarcz, an HIV epidemiologist at the San Francisco Department of Public Health.
Today in the US severe immune deficiencies resulting in IOs are seen primarily among people who are not diagnosed with HIV before the final course of infection. People who start treatment but can not sustain sustained viral suppression and a good T-CD4 cell count also remains at risk.
San Francisco is known for its good health services for people living with HIV, and areas with poor access to skilled care may have the highest OI mortality rates. All over the country, The CDC estimates that 86% of people living with HIV in 2011 had been diagnosed, for 37% were prescribed ART, and only 30% obtained an undetectable viral load.
"The importance of the so-called care cascade, including early diagnosis of HIV infection, effective linkage to care, long-term retention in care, and durable viral suppression, has long been recognized as fundamental to gain control over the various aspects of the epidemic, including obtaining good clinical results in infected individuals, "wrote Henry Masur and Sarah from the National Institute of Allergy and Infectious Diseases in a Comment on follow up.
"San Francisco may be a better scenario to reduce mortality risk associated with opportunistic infections related to AIDS," he continued. "However, even with more than 30 years of efforts and commitment from all relevant and relevant stakeholders in San Francisco, the current report illustrates that opportunistic infections related to HIV continue to occur and that patients still die at alarming rates during the first years after its first AIDS-related opportunistic infection is recognized ... A mortality rate of 35% in 5 years after the initial diagnosis of AIDS-defining opportunistic infection leaves great room for improvement. "
Written by Liz Highleyman
Translated by Claudio Souza from the original in People with HIV Still at Risk for Opportunistic Illness Death Despite Dramatic Survival Gains
Although the text always refers to "IO" of Opportunistic Infections, opportunistic illness does not always result from an "infection". There are cases of cancers, such as Sarkoma's sarcoma, which do not originate from any infection and yet is a Opportunistic Illness. I have kept the expression on account of a scruple to remain faithful to the text, and yet I make this observation here (...).
Editor's Note Soropositivo Web Site:
Although there is still the possibility of "going to death" within five years after the manifestation of an opportunistic disease, much improved the prognosis for people who have just received HIV seropositive diagnosis. I very much recall hearing from the mouth of the "health professional" who gave me the result that I, at 1994, was six months old (Complete on November 13, twenty-three years of serologically conscious life). Reading this text should lead you, who reads this text at this time and who thinks that it may be one of the 100,000 people who are infected with HIV.
Do it yourself and quickly test as quickly as possible, since this lowers the chances, if you are HIV positive, to develop or install an opportunistic illness. Having AIDS is not good! having and not knowing and not treating is much worse!
K Djawe, K Buchacz, L Hsu, et al. Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons - San Francisco, 1981-2012. Journal of Infectious Diseases. June 3, 2015 (Epub ahead of print).
H Masur and S Read. Opportunistic Infections and Mortality: Still Room for Improvement. Journal of Infectious Diseases. June 3, 2015 (Epub ahead of print).
Infectious Diseases Society of America. Thirty Years of AIDS Data Highlight Survival Gains, Room for Improvement. Press release. June 4, 2015.