I see. Bacterial infections do not affect heterosexuals. Fascinating.

Must be a whole heck of a lot of us same gender loving folks!

Huh.

So  you support killing people with AIDS? Wow. Pretty despicable,
there Susie-frodlet.

Of course, the article doesn't say that. Indeed, here's another
article about what happens to folks with HIV who maintain higher CD4
counts.

ARV toxicities can be lethal. Untreated HIV infection tends to be more
lethal. Risk and benefit.

Sorry the tables don't come through here, but one can go to the NATAP
website.

        George M. Carter

**
NATAP http://natap.org/
_______________________________________________
Why people with HIV die (or don't) today

Written for NATAP
A Report from the 10th European AIDS Conference (EACS), November
17-20, 2005, Dublin; extracted from 3rd EACS Report.
Mark Mascolini

Two big cohort studies yielded two surprises about mortality among
people taking potent antiretrovirals for 5 years or more:

o     CASCADE cohort researchers reported that-contrary to results of
other studies-opportunistic infections remain the leading cause of
death among people with HIV [7].
o     APROCO and Aquitaine cohort collaborators found that people who
attain and maintain a CD4 count above 500 cells/µL live as long as
people without HIV [8].

Soaking up data from 22 cohorts of people with known HIV
seroconversion dates, the CASCADE crew set out to compare causes of
death in the pre-HAART era with causes since potent regimens gained
wide use in developed countries. Of the 7680 cohort members included,
1962 died, 504 of them from unknown causes.

Ronald Geskus from the Health Service of Amsterdam reported that rates
of progression to almost all causes of death dropped-as one would
expect-since strong triple therapies arrived. After about 15 years of
follow-up in both the pre-HAART and the HAART groups, opportunistic
infections proved the most common killer in both eras. But cumulative
incidence of death from opportunistic infection during the days of
HAART was only about 25% the incidence in pre-HAART years.

After opportunistic infection the most frequent relative causes of
death changed greatly when muscular regimens gained sway (Table):

Leading causes of death in the CASCADE cohort
[table not uploadable]

The biggest shifts in the HAART era involved a hefty relative jump in
intentional and unintentional death (which are probably nice ways to
say suicide and murder), a higher relative rate of death from liver
failure, and a higher relative rate of death from heart disease or
diabetes.

Geskus and colleagues reported that the greater relative frequency of
intentional and unintentional death in the HAART epoch reflects a
significant jump in such deaths among injecting drug users. They call
the relative surge in liver-related deaths a nonsignificant trend.

Together the APROCO and Aquitaine cohorts embrace 1743 men and 536
women who began a PI regimen from 1997 through 1999 and logged 5 years
of follow-up. Charlotte Lewden from INSERM Unit 593 in Bordeaux
reported that the combined group had a median 4.4-year duration of HIV
infection before treatment, a median pretreatment CD4 count of 270
cells/µL, and a median pretreatment viral load of 4.5 log copies/mL.
Lewden and colleagues documented HCV coinfection in 27% of these
people, and 21% had AIDS when they started their PI.

Death rates per 100 person-years skidded from 11.3 in 1996 to 5.1 in
1997, 3.5 in 1998, 1.8 in 1999, and 1.9 in 2000. After that, though,
mortality inched back up to 3.8 per 100 person-years in 2003. Lewden
did not parse this uptick.

The French team figured a standardized mortality ratio as observed
deaths divided by expected deaths-stratified by age and gender-with
1999 French death rates as the point of reference. The overall
standardized mortality ratio showed a 7.8 times higher death risk in
the HIV cohorts than in the general population and even higher risks
for injecting drug users (18.6 times), women (14.1 times), and people
with HCV coinfection (13.6 times) (Table).

But people with at least two recorded CD4 counts above 500 cells/µL,
no recorded count under 500 cells/µL, and no viral load at or above
100,000 copies/mL had a standardized mortality ratio of 1.1 compared
with the general population. In other words, the difference between
their death rate and that of the general population-if there is a
difference-must be negligible.

Mortality rate in 2279 French cohort members: 1/1997 to 6/2003
[table not uploadable]

*See text for definition.

Lewden and coworkers argued that their findings mean HIV infection
“might no longer be considered as an obstacle to obtain insurance
contracts and loans� if a person reaches and keeps a CD4 count above
500 cells/µL.

References

7. Geskus R, Geskus R, Porter K, et al. Has effective therapy altered
the spectrum of cause-specific mortality following HIV seroconversion?
10th European AIDS Conference. November 17-20, 2005. Dublin. Abstract
PE18.4/6.
8. Lewden C, APROCO-COPILOTE Study Group. Responses to antiretroviral
treatment over 500 CD4/mm3 reach same mortality rates as general
population: APROCO and Acquitaine cohorts, France. 10th European AIDS
Conference. November 17-20, 2005. Dublin. Abstract PE18.4/8.

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