0
May 1, 1996, Vol 275, No. 17 >
ARTICLE | May 1, 1996

Survival From Early, Intermediate, and Late Stages of HIV Infection FREE

Cheryl Enger, PhD; Neil Graham, MD, MPH; Yun Peng; Joan S. Chmiel, PhD; Lawrence A. Kingsley, DrPH; Roger Detels, MD, MS; Alvaro Muñoz, PhD
[+] Author Affiliations

Reprints: Alvaro Muñoz, PhD, Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, 624 N Broadway, Suite 797, Baltimore, MD 21205.


JAMA. 1996;275(17):1329-1334. doi:10.1001/jama.1996.03530410043031
Text Size: A A A
Published online
Article
References

Objective.  —To estimate expected survival time among homosexual men infected with the human immunodeficiency virus type 1 (HIV-1) by (1) the calendar period before (1985-1988) and after (1989-1993) the widespread availability of acquired immunodeficiency syndrome (AIDS) treatments with antiretroviral and prophylactic interventions, and (2) stage of HIV disease.

Design.  —A prospective cohort study. A group of HIV-1—infected homosexual men were followed from July 1985 through June 1993 and evaluated every 6 months for the presence of clinical symptoms and measurement of the CD4 cell count. To measure the effectiveness of AIDS therapies in this nonrandomized study, we used 2 calendar periods as proxy measures of relative intensity of exposure to antiretroviral therapy. Stage of infection was defined by CD4 cell count and presence of HIV-related clinical symptoms or AIDS.

Setting and Study Participants.  —Homosexual men infected with HIV-1 from the Multicenter AIDS Cohort Study.

Main Outcome Measure.  —Survival time based on stage of HIV infection.

Results.  —The percentage of HIV-1—infected individuals free of AIDS and clinical symptoms at baseline who survived 2.5 years according to baseline CD4 cell counts of 0 to 0.100, 0.101 to 0.200, and 0.201 to 0.350× 109/L was 22%, 53%, and 83%, respectively, for the 1985-1988 calendar period, compared with 54%, 71%, and 91%, respectively, for men in the 1989-1993 calendar period. Among men free of AIDS with CD4 cell counts of greater than 0.350× 109/L, the relative hazard of mortality was 1.6 to 2.3 times higher for those with clinical symptoms compared with those free of clinical symptoms.

Conclusions.  —Survival of AIDS-free HIV-1—infected individuals with CD4 cell counts of less than 0.350× 109/L has improved since antiretroviral and HIV prophylactic treatments have become available, but the long-term prognosis remains poor.(JAMA. 1996;275:1329-1334)

REFERENCES

1 +
Alcabes P, Munõz A, Vlahov D, Friedland GH.  Incubation period of human immunodeficiency virus. Epidemiol Rev . 1993;;15:303-318.
2 +
Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B.  Survival with the acquired immunodeficiency syndrome: experience with 5833 cases in New York City. N Engl J Med . 1987;;317:1297-1302.
3 +
Lemp GF, Payne SF, Neal D, Temelso T, Rutherford GW.  Survival trends for patients with AIDS. JAMA . 1990;;263:402-406.
4 +
Harris JE.  Improved short-term survival of AIDS patients initially diagnosed with Pneumocystis carinii pneumonia, 1984 through 1987. JAMA . 1990;; 263:397-401.
5 +
Moore RD, Hidalgo J, Sugland BW, Chaisson RE.  Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med . 1991;;324:1412-1416.
6 +
Jacobson LP, Kirby AJ, Polk S, et al.  Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991. Am J Epidemiol . 1993;; 138:952-964.
7 +
Osmond D, Charlebois E, Lang W, Shiboski S, Moss A.  Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993. JAMA . 1994;;271:1083-1087.
8 +
Bacchetti P, Osmond D, Chaisson RE, et al.  Survival patterns of the first 500 patients with AIDS in San Francisco. J Infect Dis . 1988;;157:1044-1047.
9 +
Hoover DR, Saah AJ, Bacellar H, et al, for the Multicenter AIDS Cohort Study.  Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis. N Engl J Med . 1993;;329:1922-1926.
10 +
Fischl MA, Richman DD, Hansen N, et al, and the AIDS Clinical Trials Group.  The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. Ann Intern Med . 1990;;112:727-737.
11 +
Volberding PA, Lagakos SW, Koch MA, et al, and the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.  Zidovudine in asymptomatic human immunodeficiency virus infection: a controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. N Engl J Med . 1990;;322:941-949.
12 +
Graham NMH, Zeger SL, Park LP, et al, and the Multicenter AIDS Cohort Study.  Effect of zidovudine and Pneumocystis carinii pneumonia prophylaxis on progression of HIV-1 infection to AIDS. Lancet . 1991;;338:265-269.
13 +
Cooper DA, Gatell JM, Kroon S, et al, and the European-Australian Collaborative Group.  Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. N Engl J Med . 1993;;329:297-303.
14 +
Vella S, Giuliano M, Dally LG, et al, and the Italian Zidovudine Evaluation Group.  Long-term follow-up of zidovudine therapy in asymptomatic HIV infection: results of a multicenter cohort study. J Acquir Immune Defic Syndr . 1994;;7:31-38.
15 +
Fischl MA, Richman D, Grieco MH, et al, and the AZT Collaborative Working Group.  The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med . 1987;;317:185-191.
16 +
Vella S, Giuliano M, Pezzotti P, et al, for the Italian Zidovudine Evaluation Group.  Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients. JAMA . 1992;;267:1232-1236.
17 +
Saah AJ, Hoover DR, He Y, Kingsley LA, Phair JP, and the Multicenter AIDS Cohort Study.  Factors influencing survival after AIDS: report from the Multicenter AIDS Cohort Study (MACS). J Acquir Immune Defic Syndr . 1994;;7:287-295.
18 +
Buira E, Gatell JM, Miro JM, et al.  Influence of treatment with zidovudine (ZDV) on the long-term survival of AIDS patients. J Acquir Immune Defic Syndr . 1992;;5:737-742.
19 +
Graham NMH, Zeger SL, Park LP, et al.  The effects on survival of early treatment of human immunodeficiency virus infection. N Engl J Med . 1992;;326:1037-1042.
20 +
Hamilton JD, Hartigan PM, Simberkoff MS, et al, and the Veterans Affairs Cooperative Study Group on AIDS Treatment.  A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection: results of the Veterans Affairs Cooperative Study. N Engl J Med . 1992;;326:437-443.
21 +
Concorde Coordinating Committee.  Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Lancet . 1994;;343:871-881.
22 +
Volberding PA, Lagakos SW, Grimes JM, et al, for the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.  The duration of zidovudine benefit in persons with asymptomatic HIV infection: prolonged evaluation of Protocol 019 of the AIDS Clinical Trials Group. JAMA . 1994;;272:437-442.
23 +
Lundgren JD, Phillips AN, Pedersen C, et al, for the AIDS in Europe Study Group.  Comparison of long-term prognosis of patients with AIDS treated and not treated with zidovudine. JAMA . 1994;;271: 1088-1092.
24 +
Kaslow RA, Ostrow DG, Detels R, et al, for the Multicenter AIDS Cohort Study.  The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol . 1987;;126:310-318.
25 +
Muñoz A, Schrager LK, Bacellar H, et al.  Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985-1991. Am J Epidemiol . 1993;;137:423-438.
26 +
Graham NMH, Zeger SL, Kuo V, et al, and the Multicenter AIDS Cohort Study.  Zidovudine use in AIDS-free HIV-1-seropositive homosexual men in the Multicenter AIDS Cohort Study (MACS), 1987-1989. J Acquir Immune Defic Syndr . 1991;;4:267-276.
27 +
Graham NMH, Jacobson LP, Kuo V, Chmiel JS, Morgenstern H, Zucconi SL.  Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992. J Clin Epidemiol . 1994;;47:1003-1012.
28 +
Muñoz A, Carey V, Taylor JMG, et al.  Estimation of time since exposure for a prevalent cohort. Stat Med . 1992;;11:939-952.
29 +
Giorgi JV, Cheng H-L, Margolick JB, et al, and the Multicenter AIDS Cohort Study Group.  Quality control in the flow cytometric measurement of T-lymphocyte subsets: the Multicenter AIDS Cohort Study experience. Clin Immunol Immunopathol . 1990;;55:173-186.
30 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
31 +
Cox DR, Oakes D. Analysis of Survival Data . London, England: Chapman & Hall Ltd; 1984;.
32 +
Zeger SL, Liang KY.  Longitudinal data analysis for discrete and continuous outcomes. Biometrics . 1986;;42:121-130.
33 +
Phillips AN, Sabin CA, Elford J, Bofill M, Janossy G, Lee CA.  Acquired immunodeficiency syndrome (AIDS) risk in recent and long-standing human immunodeficiency virus type 1 (HIV-1)-infected patients with similar CD4 lymphocyte counts. Am J Epidemiol . 1993;;138:870-878.
34 +
Kirby AJ, Muñoz A, Detels R, Armstrong JA, Saah A, Phair JP.  Thrush and fever as measures of immunocompetence in HIV-1-infected men. J Acquir Immune Defic Syndr . 1994;;7:1242-1249.
35 +
Muñoz A, Vlahov D, Solomon L, et al.  Prognostic indicators for development of AIDS among intravenous drug users. J Acquir Immune Defic Syndr . 1992;;5:694-700.
36 +
Gail MH.  Use of observational data for evaluating AIDS therapies.  In: Finkelstein DM, Schoenfeld DA, eds. AIDS Clinical Trials . New York, NY: Wiley-Liss Inc; 1995;:403-422.
37 +
Muñoz A, Hoover D.  Use of cohort studies for evaluating AIDS therapies.  In: Finkelstein DM, Schoenfeld DA, eds. AIDS Clinical Trials . New York, NY: Wiley-Liss Inc; 1995;:423-446.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Alcabes P, Munõz A, Vlahov D, Friedland GH.  Incubation period of human immunodeficiency virus. Epidemiol Rev . 1993;;15:303-318.
2 +
Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B.  Survival with the acquired immunodeficiency syndrome: experience with 5833 cases in New York City. N Engl J Med . 1987;;317:1297-1302.
3 +
Lemp GF, Payne SF, Neal D, Temelso T, Rutherford GW.  Survival trends for patients with AIDS. JAMA . 1990;;263:402-406.
4 +
Harris JE.  Improved short-term survival of AIDS patients initially diagnosed with Pneumocystis carinii pneumonia, 1984 through 1987. JAMA . 1990;; 263:397-401.
5 +
Moore RD, Hidalgo J, Sugland BW, Chaisson RE.  Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med . 1991;;324:1412-1416.
6 +
Jacobson LP, Kirby AJ, Polk S, et al.  Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991. Am J Epidemiol . 1993;; 138:952-964.
7 +
Osmond D, Charlebois E, Lang W, Shiboski S, Moss A.  Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993. JAMA . 1994;;271:1083-1087.
8 +
Bacchetti P, Osmond D, Chaisson RE, et al.  Survival patterns of the first 500 patients with AIDS in San Francisco. J Infect Dis . 1988;;157:1044-1047.
9 +
Hoover DR, Saah AJ, Bacellar H, et al, for the Multicenter AIDS Cohort Study.  Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis. N Engl J Med . 1993;;329:1922-1926.
10 +
Fischl MA, Richman DD, Hansen N, et al, and the AIDS Clinical Trials Group.  The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. Ann Intern Med . 1990;;112:727-737.
11 +
Volberding PA, Lagakos SW, Koch MA, et al, and the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.  Zidovudine in asymptomatic human immunodeficiency virus infection: a controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. N Engl J Med . 1990;;322:941-949.
12 +
Graham NMH, Zeger SL, Park LP, et al, and the Multicenter AIDS Cohort Study.  Effect of zidovudine and Pneumocystis carinii pneumonia prophylaxis on progression of HIV-1 infection to AIDS. Lancet . 1991;;338:265-269.
13 +
Cooper DA, Gatell JM, Kroon S, et al, and the European-Australian Collaborative Group.  Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. N Engl J Med . 1993;;329:297-303.
14 +
Vella S, Giuliano M, Dally LG, et al, and the Italian Zidovudine Evaluation Group.  Long-term follow-up of zidovudine therapy in asymptomatic HIV infection: results of a multicenter cohort study. J Acquir Immune Defic Syndr . 1994;;7:31-38.
15 +
Fischl MA, Richman D, Grieco MH, et al, and the AZT Collaborative Working Group.  The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med . 1987;;317:185-191.
16 +
Vella S, Giuliano M, Pezzotti P, et al, for the Italian Zidovudine Evaluation Group.  Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients. JAMA . 1992;;267:1232-1236.
17 +
Saah AJ, Hoover DR, He Y, Kingsley LA, Phair JP, and the Multicenter AIDS Cohort Study.  Factors influencing survival after AIDS: report from the Multicenter AIDS Cohort Study (MACS). J Acquir Immune Defic Syndr . 1994;;7:287-295.
18 +
Buira E, Gatell JM, Miro JM, et al.  Influence of treatment with zidovudine (ZDV) on the long-term survival of AIDS patients. J Acquir Immune Defic Syndr . 1992;;5:737-742.
19 +
Graham NMH, Zeger SL, Park LP, et al.  The effects on survival of early treatment of human immunodeficiency virus infection. N Engl J Med . 1992;;326:1037-1042.
20 +
Hamilton JD, Hartigan PM, Simberkoff MS, et al, and the Veterans Affairs Cooperative Study Group on AIDS Treatment.  A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection: results of the Veterans Affairs Cooperative Study. N Engl J Med . 1992;;326:437-443.
21 +
Concorde Coordinating Committee.  Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Lancet . 1994;;343:871-881.
22 +
Volberding PA, Lagakos SW, Grimes JM, et al, for the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.  The duration of zidovudine benefit in persons with asymptomatic HIV infection: prolonged evaluation of Protocol 019 of the AIDS Clinical Trials Group. JAMA . 1994;;272:437-442.
23 +
Lundgren JD, Phillips AN, Pedersen C, et al, for the AIDS in Europe Study Group.  Comparison of long-term prognosis of patients with AIDS treated and not treated with zidovudine. JAMA . 1994;;271: 1088-1092.
24 +
Kaslow RA, Ostrow DG, Detels R, et al, for the Multicenter AIDS Cohort Study.  The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol . 1987;;126:310-318.
25 +
Muñoz A, Schrager LK, Bacellar H, et al.  Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985-1991. Am J Epidemiol . 1993;;137:423-438.
26 +
Graham NMH, Zeger SL, Kuo V, et al, and the Multicenter AIDS Cohort Study.  Zidovudine use in AIDS-free HIV-1-seropositive homosexual men in the Multicenter AIDS Cohort Study (MACS), 1987-1989. J Acquir Immune Defic Syndr . 1991;;4:267-276.
27 +
Graham NMH, Jacobson LP, Kuo V, Chmiel JS, Morgenstern H, Zucconi SL.  Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992. J Clin Epidemiol . 1994;;47:1003-1012.
28 +
Muñoz A, Carey V, Taylor JMG, et al.  Estimation of time since exposure for a prevalent cohort. Stat Med . 1992;;11:939-952.
29 +
Giorgi JV, Cheng H-L, Margolick JB, et al, and the Multicenter AIDS Cohort Study Group.  Quality control in the flow cytometric measurement of T-lymphocyte subsets: the Multicenter AIDS Cohort Study experience. Clin Immunol Immunopathol . 1990;;55:173-186.
30 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
31 +
Cox DR, Oakes D. Analysis of Survival Data . London, England: Chapman & Hall Ltd; 1984;.
32 +
Zeger SL, Liang KY.  Longitudinal data analysis for discrete and continuous outcomes. Biometrics . 1986;;42:121-130.
33 +
Phillips AN, Sabin CA, Elford J, Bofill M, Janossy G, Lee CA.  Acquired immunodeficiency syndrome (AIDS) risk in recent and long-standing human immunodeficiency virus type 1 (HIV-1)-infected patients with similar CD4 lymphocyte counts. Am J Epidemiol . 1993;;138:870-878.
34 +
Kirby AJ, Muñoz A, Detels R, Armstrong JA, Saah A, Phair JP.  Thrush and fever as measures of immunocompetence in HIV-1-infected men. J Acquir Immune Defic Syndr . 1994;;7:1242-1249.
35 +
Muñoz A, Vlahov D, Solomon L, et al.  Prognostic indicators for development of AIDS among intravenous drug users. J Acquir Immune Defic Syndr . 1992;;5:694-700.
36 +
Gail MH.  Use of observational data for evaluating AIDS therapies.  In: Finkelstein DM, Schoenfeld DA, eds. AIDS Clinical Trials . New York, NY: Wiley-Liss Inc; 1995;:403-422.
37 +
Muñoz A, Hoover D.  Use of cohort studies for evaluating AIDS therapies.  In: Finkelstein DM, Schoenfeld DA, eds. AIDS Clinical Trials . New York, NY: Wiley-Liss Inc; 1995;:423-446.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems