Surviving HIV

A comprehensive study quantifies a dramatic increase in survival chances over the past decade

People who contracted HIV through sexual contact during the 1980s or early 1990s faced an 8 to 23 percent risk, depending on age, of dying within five years of infection.

Now, that same risk is close to nil, a new study finds.

The sharply lower mortality risk stems directly from a combination of anti-HIV drugs known by the slightly misleading abbreviation HAART, for highly active antiretroviral therapy.

HAART is a drug cocktail that interferes with a virus’s ability to copy its genetic information. This drug combination first reached doctors’ offices in the mid-1990s and, with ongoing modifications, has become the standard prescription for HIV-positive people in industrialized countries since then, says study coauthor Kholoud Porter, an epidemiologist at the Medical Research Council in London.

Previous studies have reported survival gains among HIV-positive people, but the new study is the first to track closely the date of infection in these patients, Porter says.

To do that, she and a team of researchers analyzed medical records of 16,534 HIV-positive people in Europe, Canada and Australia who were monitored from 1981 to 2006. On average, the scientists were able to measure the progress of these people and medication taken by them for more than six years per person. By the end of 2006, 2,571 had died.

Data collected before 1996 show that people infected in those years preceding HAART faced steep survival odds. About 8 to 16 percent who acquired HIV before the age of 45 died in the first five years back then and 42 to 61 percent died within the first 10 years. For people over 45, the numbers were even worse — 23 percent died in the first five years and 60 percent within the first 10 years.

In contrast, the data collected from 2004 through 2006 — which included information about many people who have acquired HIV in the past decade or so — showed that those infected while under age 45 were no more likely to die within the first five years of being HIV-positive than were others their age in the general population. And 10-year death rates were less than 5 percent, only slightly higher than the public average.

For these recent arrivals to the HIV epidemic who were over age 45 at the point of infection, five-year mortality was 5 percent and 10-year death rates were 12 percent, somewhat higher than the general population but still a sharp drop from earlier decades. The report appears in the July 2 Journal of the American Medical Association.

“This gives us a reasonably accurate estimate of the positive benefits of introducing antiviral therapy and really shows the improvement in the quality and availability of antivirals over time and their impact on mortality,” says Jeffrey Nadler, an infectious disease physician at the National Institute of Allergy and Infectious Diseases in Bethesda, Md.

These figures apply only to people who become infected by sexual contact. Those who get HIV via injected-drug use have worse survival, other research suggests. That’s probably because they adhere to drug regimens poorly, live a more chaotic life and often have other infections such as hepatitis C, Porter says.

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