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Medical Forum / Diseases and Disorders / AIDS / May 2007Diagnosed HIV+ people have 4% chance of dying from AIDS
My back of an envelope calculations suggest someone diagnosed HIV+ has a 4% chance of dying from AIDS, and that percentage is dwindling. The UK has about 7,000 new HIV+ diagnosis per year. Actual figures for the past few years are <http://www.avert.org/statsyr.htm>: 2000 3,881 2001 5,099 2002 6,264 2003 7,339 2004 7,552 2005 7,645 2006 6,642 I found it extremely difficult to find the UK's figures for AIDS deaths. I think there's a bit of a problem here with using the term AIDS, anyway I managed to find them: <http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/hiv/epidemiology/files/qu arterly.pdf>. Death from AIDS for the past few years: 2000 295 2001 272 2002 237 2003 297 2004 225 2005 177 So, in the UK about 7,000 people are diagnosed HIV+ each year, and about 300 people die each year from AIDS. For the numerically challenged that's 4.3%. The figure for AIDS deaths is really probably less than 250, but I don't want to be accused of fiddling the figures, so I've rounded it up to the nearest hundred. The number of diagnosed HIV+ cases is on the rise, but deaths from AIDS are falling. Interestingly, those diagnosed HIV+ are now more likely to die from something other than AIDS.  SignatureShould I begin ART? Vote: <http://hiv-positive.freehostia.com/vote/> >My back of an envelope calculations suggest someone diagnosed HIV+ has >a 4% chance of dying from AIDS, and that percentage is dwindling. That's because of the advent of antiretroviral therapy. GMCarter wrote... >>My back of an envelope calculations suggest someone diagnosed HIV+ has >>a 4% chance of dying from AIDS, and that percentage is dwindling. > > That's because of the advent of antiretroviral therapy. Actually, you're dead from the moment of infection. A side-effect of the virus is that it causes the host to continue moving long after death has occurred. The movements can be so complex as to resemble life, but it really is only a state of animation. An alternative theory is that people who manage to contract the virus are so dumb that they don't even realize that they're dead and keep moving. >GMCarter wrote... >> [quoted text clipped - 4 lines] > >Actually, you're dead from the moment of infection. Actually, you've been dead for eons. >>My back of an envelope calculations suggest someone diagnosed HIV+ has >>a 4% chance of dying from AIDS, and that percentage is dwindling. >That's because of the advent of antiretroviral therapy. HAART's introduction in the UK occurred in 1997. This article <http://www.innovations-report.de/html/berichte/medizin_gesundheit/bericht-22469.html> mentions: "Using data from a large collaboration of 22 studies in Europe, Australia, and Canada (CASCADE), Kholoud Porter from the UK Medical Research Council Clinical Trials Unit and colleagues assessed the continuing effect of HAART on survival and progression to AIDS after HIV-1 seroconversion (the point at which antibodies to HIV-1 infection are detectable in blood). The investigators compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART)." Which suggests HAART's widespread use didn't begin until 1999. However I haven't yet found any specific details about HAART prescribing practices in the UK. Interestingly AIDS diagnosis and deaths had stabilised and began to fall before 1997. Arguably the introduction of HARRT has caused those falls to level off. AIDS diagnoses: 1992 1579 1993 1789 1994 1853 1995 1770 1996 1442 1997 1079 1998 794 1999 762 2000 833 AIDS deaths: 1992 1094 1993 1359 1994 1531 1995 1514 1996 1236 1997 566 1998 345 1999 308 2000 295 SignatureShould I begin ART? Vote: <http://hiv-positive.freehostia.com/vote/> >>My back of an envelope calculations suggest someone diagnosed HIV+ has >>a 4% chance of dying from AIDS, and that percentage is dwindling. > >That's because of the advent of antiretroviral therapy. Your claim might have some validity if everyone HIV+ were on ART. However, that is certainly not the case- http://gateway.nlm.nih.gov/MeetingAbstracts/102250648.html >>>My back of an envelope calculations suggest someone diagnosed HIV+ has >>>a 4% chance of dying from AIDS, and that percentage is dwindling. [quoted text clipped - 5 lines] > >http://gateway.nlm.nih.gov/MeetingAbstracts/102250648.html I was a bit surprised to learn there are about 38,000 people taking ART in the UK <http://uk.gay.com/article/5516>, which is well over half of those diagnosed HIV+ (about 70,000). I feel very sorry for them. Doctors have tried to persuade me to take the drugs, and even knowing what I know I find it difficult not to get swept along with it all. It can be difficult to think rationally when everyone around is telling your you're going to die. Just look at the comments I've received here. SignatureShould I begin ART? Vote: <http://hiv-positive.freehostia.com/vote/> "HIV Positive" <hiv.positive@gmail.com> wrote in message > I was a bit surprised to learn there are about 38,000 people taking > ART in the UK <http://uk.gay.com/article/5516>, which is well over > half of those diagnosed HIV+ (about 70,000). Say it is 50%. Which half is doing better? >"HIV Positive" <hiv.positive@gmail.com> wrote in message >> [quoted text clipped - 3 lines] > >Say it is 50%. Which half is doing better? Well, *doing better* is subjective. Doing better with regard to blood tests? Doing better with regard to quality of life? Doing better with regard to liver function? It is too hard to determine which group is doing better. However, based on the stats HIV Positive posted- In 2005 there were 177 deaths related to AIDS out of about 70,000 infections where about 54% use ARVT and the balance does not. IMO, a couple questions would be- what were the causes of death for the 177? And, for the 177 deaths how many were using ARV and how many were not? >>"HIV Positive" <hiv.positive@gmail.com> wrote in message >>> [quoted text clipped - 13 lines] >couple questions would be- what were the causes of death for the 177? >And, for the 177 deaths how many were using ARV and how many were not? If you don't use ARV, chances of dying from AIDS are extremely high. ARV reduces that risk. You don't want to take ARV, that's absolutely your choice. George M. Carter ** Schneider MF, Gange SJ, Williams CM, Anastos K, Greenblatt RM, Kingsley L, Detels R, Munoz A. Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984-2004. AIDS. 2005 Nov 18;19(17):2009-18. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, MD 21205, USA. OBJECTIVE: To characterize changing survival patterns after development of clinical AIDS from 1984 to 2004, when different antiretroviral therapies were being introduced. DESIGN: Cohort of homosexual men since 1984 and cohort of women since 1994. METHODS: A total of 1504 men and 461 women were followed for all-cause mortality after an incident AIDS diagnosis. Relative hazards of death and relative times to death were determined in five therapy eras: no/monotherapy (July 1984-December 1989), monotherapy/combination therapy (January 1990-December 1994), HAART introduction (January 1995-June 1998), short-term stable HAART use (July 1998-June 2001), and moderate-term stable HAART use (July 2001-December 2003). RESULTS: A total of 1057 (54%) study participants died. The time at which 25% of individuals died after an AIDS diagnosis increased significantly from 0.56 years [95% confidence interval (CI), 0.50-0.64] in the no/monotherapy era to 0.74 (95% CI, 0.67-0.82), 1.78 (95% CI, 1.29-2.44), 4.22 (95% CI, 2.94-6.05) and 5.08 years (95% CI, 2.39-10.79) in the four subsequent therapy eras, respectively. Inferences on the beneficial effects of HAART were confirmed after adjustment by age, sex, type of AIDS diagnosis and CD4 cell count at diagnosis. The pattern of the hazard of death after AIDS changed from increasing in the pre-HAART era to being lower and non-increasing in the eras of HAART. CONCLUSIONS: The sustained beneficial effect of HAART, even in individuals with clinical AIDS and extensive treatment histories, attenuates concerns about emergence of resistance but augurs that a substantial number of HIV-infected individuals may require care for very long periods. PMID: 16260908 [PubMed - indexed for MEDLINE] *** Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, Costagliola D, D'Arminio Monforte A, de Wolf F, Reiss P, Lundgren JD, Justice AC, Staszewski S, Leport C, Hogg RS, Sabin CA, Gill MJ, Salzberger B, Sterne JA; ART Cohort Collaboration. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002 Jul 13;360(9327):119-29. Erratum in: Lancet 2002 Oct 12;360(9340):1178. Department of Social and Preventive Medicine, University of Bern, CH-3012 Bern, Switzerland. egger@ispm.unibe.ch BACKGROUND: Insufficient data are available from single cohort studies to allow estimation of the prognosis of HIV-1 infected, treatment-naive patients who start highly active antiretroviral therapy (HAART). The ART Cohort Collaboration, which includes 13 cohort studies from Europe and North America, was established to fill this knowledge gap. METHODS: We analysed data on 12,574 adult patients starting HAART with a combination of at least three drugs. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions. We considered progression to a combined endpoint of a new AIDS-defining disease or death, and to death alone. The prognostic model that generalised best was a Weibull model, stratified by baseline CD4 cell count and transmission group. FINDINGS During 24,310 person-years of follow up, 1094 patients developed AIDS or died and 344 patients died. Baseline CD4 cell count was strongly associated with the probability of progression to AIDS or death: compared with patients starting HAART with less than 50 CD4 cells/microL, adjusted hazard ratios were 0.74 (95% CI 0.62-0.89) for 50-99 cells/microL, 0.52 (0.44-0.63) for 100-199 cells/microL, 0.24 (0.20-0.30) for 200-349 cells/microL, and 0.18 (0.14-0.22) for 350 or more CD4 cells/microL. Baseline HIV-1 viral load was associated with a higher probability of progression only if 100,000 copies/microL or above. Other independent predictors of poorer outcome were advanced age, infection through injection-drug use, and a previous diagnosis of AIDS. The probability of progression to AIDS or death at 3 years ranged from 3.4% (2.8-4.1) in patients in the lowest-risk stratum for each prognostic variable, to 50% (43-58) in patients in the highest-risk strata. INTERPRETATION: The CD4 cell count at initiation was the dominant prognostic factor in patients starting HAART. Our findings have important implications for clinical management and should be taken into account in future treatment guidelines. PMID: 12126821 [PubMed - indexed for MEDLINE] >>>"HIV Positive" <hiv.positive@gmail.com> wrote in message >>>> [quoted text clipped - 16 lines] >If you don't use ARV, chances of dying from AIDS are extremely high. >ARV reduces that risk. Yes, so you say. However, I recall a time (a few weeks ago) when the only significant risk factor for oropharyngeal cancer was tobacco use. >You don't want to take ARV, that's absolutely your choice. Thanks! I was assuming that but I appreciate your flexibility. And, thanks again for the study info below but it has little to do with the question. > George M. Carter > [quoted text clipped - 81 lines] > > PMID: 12126821 [PubMed - indexed for MEDLINE] snip >>If you don't use ARV, chances of dying from AIDS are extremely high. >>ARV reduces that risk. > >Yes, so you say. However, I recall a time (a few weeks ago) when the >only significant risk factor for oropharyngeal cancer was tobacco use. Non sequitur. >>You don't want to take ARV, that's absolutely your choice. > >Thanks! I was assuming that but I appreciate your flexibility. It's also the fatal error of your life, if you are progressing to AIDS with HIV infection. >snip >>>If you don't use ARV, chances of dying from AIDS are extremely high. [quoted text clipped - 4 lines] > >Non sequitur. Yet another example of cut and run >>>You don't want to take ARV, that's absolutely your choice. >> >>Thanks! I was assuming that but I appreciate your flexibility. > >It's also the fatal error of your life, if you are progressing to AIDS >with HIV infection. >>snip >>>>If you don't use ARV, chances of dying from AIDS are extremely high. [quoted text clipped - 5 lines] >>Non sequitur. >Yet another example of cut and run Hardly. You're just another example of an idiot who wants to wallow in his hate and bigotry and not face your own evil. I pity you. >>>snip >>>>>If you don't use ARV, chances of dying from AIDS are extremely high. [quoted text clipped - 10 lines] > >I pity you. More cut and run - cannot handle the debate so you become insulting - not to mention a bit of delusional fabrication. >>>>snip >>>>>>If you don't use ARV, chances of dying from AIDS are extremely high. [quoted text clipped - 12 lines] >More cut and run - cannot handle the debate so you become insulting - >not to mention a bit of delusional fabrication. Really? Do tell! No cut and run. You made a non sequitur statement and refuse to explain it. No surprise there. "Joe B" <mong-gu-di-fu@-remove-rock.com> wrote in message > Well, *doing better* is subjective. Doing better with regard to blood > tests? Doing better with regard to quality of life? Doing better with > regard to liver function? > It is too hard to determine which group is doing better. I assumed one group would do better than the other group irregardless of subcategories, ........over all, if that helps. 1st International AIDS Society Conference on HIV Pathogenesis and Treatment Buenos Aires, Argentina - July 8-11, 2001 [TITLE:] IMPACT OF ANTIRETROVIRAL THERAPY (ARV) ON DISEASE FREE SURVIVAL IN PATIENTS WITH TUBERCULOSIS (TB) AND HIV-1 INFECTION. [AUTHOR(S):] Lourtau L, Duran A, Casanovas R, Toibaro J, Losso M Inmunocomprometidos; Htal. Ramos Mejía, Buenos Aires, Argentina IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 457 [ABSTRACT:] Objective: To describe the mortality and incidence of new AIDS defining events (ADEs) in patients with active TB receiving ARV and antiTB treatment. Materials and Methods: Retrospective review of charts corresponding to patients with HIV infection followed at our Unit between January 1993 and January 2001 looking for the presence of TB, ARV, viral load (VL), CD4+ cell counts and development of new ADEs. Results: We reviewed 833 clinical records and found 129 cases of TB, 39 of which have received ARV and concomitant antiTB drugs. Demographic data: mean age 33 years (20-58), gender M/F 83/39, heterosexual (43.4%), IDUs (31%), male homosexual (17%) and transfusion (0.7%). 39 patients (30%) received concomitant ARV therapy and TB treatment (group 1) and 90 patients (70%) received antiTB drugs alone (group 2). Main reasons because patients were not started on ARV were early lost of follow-up and late referral from TB care centers. The most common ARV regimens were 2 and 3 NRTIs (33% and 41%, respectively). Mean baseline CD4+ cell count was 118/mm3 (range 3-669). At ten month, the mean increase in group 1 and 2 were 65 and 44 cells, respectively (p:NS). Mean baseline VL was 4.8 log (range 1.9-6.2). The mean reduction in VL was 1.65 log in group 1 and 0.95 log in group 2 (p:NS). Overall mortality was 24.8%, 3.1 % in group 1 and 22.5% in group 2 (p: 0.021). The mortality in patients that survive more than 6 month was 19%, 3.7% and 15.1% respectively (p: 0.020). 30.2% of patients developed new ADEs, 9.3% in ARV group vs. 20.9% in non ARV group (p: NS). Overall survival was 19.6 months, 27.8 in group 1 and 16.3 in group 2 (Mann-Whitney test: U 965.000 p< 0001). In Kaplan-Mayer analysis, there was a significant difference between groups 1 and 2. Conclusions: These data suggest a protective effect of ARV therapy on mortality in patients with acute TB, even with non-HAART regimens. Data on the use of PIs and NNRTIs regimens compatible with Rifampin are urgently needed. 010710 457 Copyright © 2001 - International AIDS Society (IAS). |
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