Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993.

BACKGROUND

During the first decade since the recognition of the acquired immunodeficiency syndrome (AIDS), new therapies have been introduced and the frequency of clinical manifestations has changed. The impact of these changes on AIDS survival, however, has not been well characterized.

DESIGN

A prospective cohort study of the outcomes of human immunodeficiency virus (HIV) infection.

SETTING

Homosexual and bisexual men residing in San Francisco, Calif, recruited in 1983 and 1984 for two prospective studies and followed up for more than 9 years with clinical examinations.

PARTICIPANTS

A total of 761 HIV-positive homosexual and bisexual men.

MAIN OUTCOME MEASURES

Survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L (200/microL) and from a clinical AIDS diagnosis to death.

RESULTS

Median survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L increased from 28.4 months in the October 1983 to November 1986 period to 40.1 months in the November 1986 to November 1988 period and is estimated at 38.1 months in the November 1988 to February 1993 period. Patients diagnosed with Pneumocystis carinii pneumonia (PCP) accounted for most of this increase with a gain in median survival time of 9.7 months (P = .0009), compared with a nonsignificant decline in the survival time of those patients without a PCP diagnosis. Multivariate analysis showed that rate of CD4 lymphocyte loss (P < .001) and receipt of both PCP prophylaxis and antiretroviral therapy (P = .04) were significantly associated with longer survival time, whereas antiretroviral therapy alone was not (P = .81). Time to death from a clinical AIDS diagnosis was 14.7 months in the 1983 to 1986 period, 19.1 months in the 1986 to 1988 period, and an estimated 15.7 months in the 1988 to 1993 period.

CONCLUSIONS

Survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L has improved significantly by about 1 year; yet survival time using the 1987 AIDS case definition has shown small improvement. The largest increase in survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L was in patients diagnosed with PCP, suggesting that PCP prophylaxis and treatment were more important factors in longer survival time than antiretroviral therapy.