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

JAMA. 1996;275(17):1329-1334.

Abstract
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 0.350x 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 0.350x 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 0.350x 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)

Author Affiliations
From the Department of Oncology, The Johns Hopkins School of Medicine, Baltimore, Md (Dr Enger); Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Drs Graham and Muñoz and Ms Peng); Department of Preventive Medicine, Northwestern University Medical School, Chicago, Ill (Dr Chmiel); Department of Infectious Diseases and Microbiology, University of Pittsburgh (Pa) Graduate School of Public Health (Dr Kingsley); and Department of Epidemiology, UCLA School of Public Health, Los Angeles, Calif (Dr Detels).

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

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