This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (405)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Topic Collections  • HIV/AIDS  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Robert S. Hogg, MA, PhD; Katherine V. Heath, MSc; Benita Yip, BSc(Pharm); Kevin J. P. Craib, MMath; Michael V. O'Shaughnessy, PhD; Martin T. Schechter, OBC, MD, PhD, FRCPC; Julio S. G. Montaner, MD, FRCPC

JAMA. 1998;279:450-454.

Context.— Clinical trials have established the efficacy of antiretroviral therapy with double- and triple-drug regimens for individuals infected with the human immunodeficiency virus (HIV), but the effectiveness of these regimens in the population of patients not enrolled in clinical trials is unknown.

Objective.— To characterize survival following the initiation of antiretroviral therapy among HIV-infected individuals in the province of British Columbia.

Design.— Prospective, population-based cohort study of patients with antiretroviral therapy available free of charge (median follow-up, 21 months).

Setting.— Province of British Columbia, Canada.

Patients.— All HIV-positive men and women 18 years of age or older in the province who were first prescribed any antiretroviral therapy between October 1992 and June 1996 and whose CD4⁺ cell counts were less than 0.350x10⁹/L.

Main Outcome Measures.— Rates of progression from initiation of antiretroviral therapy to death or a primary acquired immunodeficiency syndrome (AIDS) diagnosis for subjects who initially received zidovudine-, didanosine-, or zalcitabine-based therapy (ERA-I) and for those who initially received therapy regimens including lamivudine or stavudine (ERA-II).

Results.— A total of 1178 patients (951 ERA-I, 227 ERA-II) were eligible. A total of 390 patients died (367 ERA-I, 23 ERA-II), yielding a crude mortality rate of 33.1%. ERA-I group subjects were almost twice as likely to die as ERA-II group subjects, with a mortality risk ratio of 1.86 (95% confidence interval [CI], 1.21-2.86; P=.005). After adjusting for Pneumocystis carinii and Mycobacterium avium prophylaxis use, AIDS diagnosis, CD4⁺ cell count, sex, and age, ERA-I participants were 1.93 times (95% CI, 1.25-2.97; P=.003) more likely to die than ERA-II participants. Among patients without AIDS when treatment was started, ERA-I participants were 2.50 times (95% CI, 1.59-3.93; P<.001) more likely to progress to AIDS or death than ERA-II participants.

Conclusion.— The HIV-infected individuals who received initial therapy with regimens including stavudine or lamivudine had significantly lower mortality and longer AIDS-free survival than those who received initial therapy with regimens limited to zidovudine, didanosine, and zalcitabine.

From the British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital (Drs Hogg, O'Shaughnessy, Schechter, and Montaner; Mss Heath and Yip; and Mr Craib), Departments of Health Care and Epidemiology (Drs Hogg, Schechter, and Montaner), Pathology (Dr O'Shaughnessy), and Medicine (Dr Montaner), Faculty of Medicine, University of British Columbia, and Canadian HIV Trials Network (Drs O'Shaughnessy, Schechter, and Montaner), Vancouver, British Columbia.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Antiretroviral Therapy and Improving AIDS Survival
Andrea De Luca, Andrea Antinori, Luigi Ortona, Robert S. Hogg, Benita Yip, Kevin J. P. Craib, Katherine V. Heath, Michael V. O'Shaughnessy, Martin T. Schechter, and Julio S. G. Montaner
JAMA. 1998;279(23):1874-1875.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Antiretroviral Tissue Kinetics: In Vivo Imaging Using Positron Emission Tomography
Di Mascio et al.
Antimicrob. Agents Chemother. 2009;53:4086-4095.
ABSTRACT | FULL TEXT  

Adherence to Medical Regimens: Understanding the Effects of Cognitive Appraisal, Quality of Life, and Perceived Family Resiliency
Frain et al.
Rehabil Couns Bull 2009;52:237-250.
ABSTRACT  

Comparison of emergency department HIV testing data with visit or patient as the unit of analysis
Lyons et al.
J Med Screen 2009;16:29-32.
ABSTRACT | FULL TEXT  

Changing Global Epidemiology of Pulmonary Manifestations of HIV/AIDS
Hull et al.
Chest 2008;134:1287-1298.
ABSTRACT | FULL TEXT  

Pharmacokinetic and Safety Evaluation of BILR 355, a Second-Generation Nonnucleoside Reverse Transcriptase Inhibitor, in Healthy Volunteers
Huang et al.
Antimicrob. Agents Chemother. 2008;52:4300-4307.
ABSTRACT | FULL TEXT  

The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya
Thirumurthy et al.
J. Human Resources 2008;43:511-552.
ABSTRACT  

Association Between Living With Children and Adherence to Highly Active Antiretroviral Therapy in the Women's Interagency HIV Study
Merenstein et al.
Pediatrics 2008;121:e787-e793.
ABSTRACT | FULL TEXT  

Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act
Burgoyne and Tan
J Antimicrob Chemother 2008;61:469-473.
ABSTRACT | FULL TEXT  

Safety and Pharmacokinetics of Bevirimat (PA-457), a Novel Inhibitor of Human Immunodeficiency Virus Maturation, in Healthy Volunteers
Martin et al.
Antimicrob. Agents Chemother. 2007;51:3063-3066.
ABSTRACT | FULL TEXT  

Hospital-Based Directly Observed Therapy for HIV-Infected Children and Adolescents to Assess Adherence to Antiretroviral Medications
Glikman et al.
Pediatrics 2007;119:e1142-e1148.
ABSTRACT | FULL TEXT  

Surgical Outcomes in Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Horberg et al.
Arch Surg 2006;141:1238-1245.
ABSTRACT | FULL TEXT  

Model for intracellular Lamivudine metabolism in peripheral blood mononuclear cells ex vivo and in human immunodeficiency virus type 1-infected adolescents.
Zhou et al.
Antimicrob. Agents Chemother. 2006;50:2686-2694.
ABSTRACT | FULL TEXT  

AIDS-related lymphoproliferative disease
Navarro and Kaplan
Blood 2006;107:13-20.
ABSTRACT | FULL TEXT  

Outcome of Critically Ill Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Khouli et al.
J Intensive Care Med 2005;20:279-285.
ABSTRACT  

Adherence to Antiretroviral Therapy: The Emerging Role of HIV Pharmacotherapy Specialists
Hardy
Journal of Pharmacy Practice 2005;18:247-257.
ABSTRACT  

Nonadherence to Antiretroviral Therapy Among a Community With Endemic Rates of Injection Drug Use
Shannon et al.
J Int Assoc Physicians AIDS Care (Chic Ill) 2005;4:66-72.
ABSTRACT  

Evaluation of HIV RNA and markers of immune activation as predictors of HIV-associated dementia
Sevigny et al.
Neurology 2004;63:2084-2090.
ABSTRACT | FULL TEXT  

Nonadherence With Pediatric Human Immunodeficiency Virus Therapy as Medical Neglect
Roberts et al.
Pediatrics 2004;114:e346-e353.
ABSTRACT | FULL TEXT  

Preclinical Pharmacology and Pharmacokinetics of GW433908, a Water-Soluble Prodrug of the Human Immunodeficiency Virus Protease Inhibitor Amprenavir
Furfine et al.
Antimicrob. Agents Chemother. 2004;48:791-798.
ABSTRACT | FULL TEXT  

Analysis of protease inhibitor combinations in vitro: activity of lopinavir, amprenavir and tipranavir against HIV type 1 wild-type and drug-resistant isolates
Bulgheroni et al.
J Antimicrob Chemother 2004;53:464-468.
ABSTRACT | FULL TEXT  

Influence of Reverse Transcriptase Variants, Drugs, and Vpr on Human Immunodeficiency Virus Type 1 Mutant Frequencies
Mansky et al.
J. Virol. 2003;77:2071-2080.
ABSTRACT | FULL TEXT  

A Two-way Messaging System to Enhance Antiretroviral Adherence
Dunbar et al.
J. Am. Med. Inform. Assoc. 2003;10:11-15.
ABSTRACT | FULL TEXT  

Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity
Hinkin et al.
Neurology 2002;59:1944-1950.
ABSTRACT | FULL TEXT  

Interruption of antiretroviral therapy to augment immune control of chronic HIV-1 infection: Risk without reward
Abbas and Mellors
Proc. Natl. Acad. Sci. USA 2002;99:13377-13378.
FULL TEXT  

Changes in the Incidence and Predictors of Wasting Syndrome Related to Human Immunodeficiency Virus Infection, 1987-1999
Smit et al.
Am J Epidemiol 2002;156:211-218.
ABSTRACT | FULL TEXT  

Dual vs Single Protease Inhibitor Therapy Following Antiretroviral Treatment Failure: A Randomized Trial
Hammer et al.
JAMA 2002;288:169-180.
ABSTRACT | FULL TEXT  

Hepatitis C and Progression of HIV Disease
Sulkowski et al.
JAMA 2002;288:199-206.
ABSTRACT | FULL TEXT  

Antiretroviral Treatment for Adult HIV Infection in 2002: Updated Recommendations of the International AIDS Society-USA Panel
Yeni et al.
JAMA 2002;288:222-235.
ABSTRACT | FULL TEXT  

Evaluation of the Effectiveness of Highly Active Antiretroviral Therapy in Persons with Human Immunodeficiency Virus using Biomarker-based Equivalence of Disease Progression
Jacobson et al.
Am J Epidemiol 2002;155:760-770.
ABSTRACT | FULL TEXT  

Unrecognized HIV Infection Among Patients Attending Sexually Transmitted Disease Clinics
Weinstock et al.
AJPH 2002;92:280-283.
ABSTRACT | FULL TEXT  

Rates of Disease Progression by Baseline CD4 Cell Count and Viral Load After Initiating Triple-Drug Therapy
Hogg et al.
JAMA 2001;286:2568-2577.
ABSTRACT | FULL TEXT  

Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy
Besson et al.
Blood 2001;98:2339-2344.
ABSTRACT | FULL TEXT  

Methods to Assess Population Effectiveness of Therapies in Human Immunodeficiency Virus Incident and Prevalent Cohorts
Tarwater et al.
Am J Epidemiol 2001;154:675-681.
ABSTRACT | FULL TEXT  

Use of Protease Inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors Among Medicaid Beneficiaries With AIDS
Sambamoorthi et al.
AJPH 2001;91:1474-1481.
ABSTRACT | FULL TEXT  

Nelfinavir, Efavirenz, or Both after the Failure of Nucleoside Treatment of HIV Infection
Albrecht et al.
NEJM 2001;345:398-407.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy for Previously Treated Patients
Montaner and Mellors
NEJM 2001;345:452-455.
FULL TEXT  

Highly Active Antiretroviral Therapy Decreases Mortality and Morbidity in Patients with Advanced HIV Disease
Murphy et al.
ANN INTERN MED 2001;135:17-26.
ABSTRACT | FULL TEXT  

Short-Term Measures of Relative Efficacy Predict Longer-Term Reductions in Human Immunodeficiency Virus Type 1 RNA Levels following Nelfinavir Monotherapy
Mittler et al.
Antimicrob. Agents Chemother. 2001;45:1438-1443.
ABSTRACT | FULL TEXT  

Management of HIV-1 Infection in Adults and Adolescents
Eugenio and Zeind
Journal of Pharmacy Practice 2000;13:426-441.
ABSTRACT  

Highly Active Antiretroviral Therapy and Incidence of Cancer in Human Immunodeficiency Virus-Infected Adults
International Collaboration on HIV and Cancer
JNCI J Natl Cancer Inst 2000;92:1823-1830.
ABSTRACT | FULL TEXT  

Selection by Indication of Potent Antiretroviral Therapy Use in a Large Cohort of Women Infected with Human Immunodeficiency Virus
Ahdieh et al.
Am J Epidemiol 2000;152:923-933.
ABSTRACT | FULL TEXT  

Differential Access in the Receipt of Antiretroviral Drugs for the Treatment of AIDS and Its Implications for Survival
Anderson and Mitchell
Arch Intern Med 2000;160:3114-3120.
ABSTRACT | FULL TEXT  

Evaluation of HIV-1 Immunogen, an Immunologic Modifier, Administered to Patients Infected With HIV Having 300 to 549 x 106/L CD4 Cell Counts: A Randomized Controlled Trial
Kahn et al.
JAMA 2000;284:2193-2202.
ABSTRACT | FULL TEXT  

AIDS-related focal brain lesions in the era of highly active antiretroviral therapy
Ammassari et al.
Neurology 2000;55:1194-1200.
ABSTRACT | FULL TEXT  

Delayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virus
Turner et al.
Arch Intern Med 2000;160:2614-2622.
ABSTRACT | FULL TEXT  

Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment
Schwenk et al.
Am. J. Clin. Nutr. 2000;72:496-501.
ABSTRACT | FULL TEXT  

Impact of Protease Inhibitors and Other Antiretroviral Treatments on Acquired Immunodeficiency Syndrome Survival in San Francisco, California, 1987-1996
Schwarcz et al.
Am J Epidemiol 2000;152:178-185.
ABSTRACT | FULL TEXT  

Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection
Paterson et al.
ANN INTERN MED 2000;133:21-30.
ABSTRACT | FULL TEXT  

Ethical Considerations in the Treatment of Infertility in Women with Human Immunodeficiency Virus Infection
Minkoff and Santoro
NEJM 2000;342:1748-1750.
FULL TEXT  

Psychological Effects of HAART: A 2-Year Study
Rabkin et al.
Psychosom. Med. 2000;62:413-422.
ABSTRACT | FULL TEXT  

Effect of Antiretroviral Therapy on Viral Load, CD4 Cell Count, and Progression to Acquired Immunodeficiency Syndrome in a Community Human Immunodeficiency Virus-Infected Cohort
Erb et al.
Arch Intern Med 2000;160:1134-1140.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy in Adults: Updated Recommendations of the International AIDS Society-USA Panel
Carpenter et al.
JAMA 2000;283:381-390.
ABSTRACT | FULL TEXT  

Bioelectrical impedance analysis in HIV-infected patients treated with triple antiretroviral treatment
Schwenk et al.
Am. J. Clin. Nutr. 1999;70:867-873.
ABSTRACT | FULL TEXT  

Effects of Anticoagulant, Processing Delay, and Assay Method (Branched DNA versus Reverse Transcriptase PCR) on Measurement of Human Immunodeficiency Virus Type 1 RNA Levels in Plasma
Kirstein et al.
J. Clin. Microbiol. 1999;37:2428-2433.
ABSTRACT | FULL TEXT  

Induction/Maintenance Treatment Regimens for HIV
Montaner
JAMA 1999;281:1680-1682.
FULL TEXT  

Gaining ground in progressive multifocal leukoencephalopathy
Dolin
Neurology 1999;52:440-440.
FULL TEXT  

The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women
Goldie et al.
ANN INTERN MED 1999;130:97-107.
ABSTRACT | FULL TEXT  

Effectiveness of Potent Antiretroviral Therapy on Time to AIDS and Death in Men With Known HIV Infection Duration
Detels et al.
JAMA 1998;280:1497-1503.
ABSTRACT | FULL TEXT  

Barriers to Use of Free Antiretroviral Therapy in Injection Drug Users
Strathdee et al.
JAMA 1998;280:547-549.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy for HIV Infection in 1998: Updated Recommendations of the International AIDS Society-USA Panel
Carpenter et al.
JAMA 1998;280:78-86.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy and Improving AIDS Survival
De Luca et al.
JAMA 1998;279:1874-1875.
FULL TEXT  

Effective AIDS Treatment Predated the Protease Inhibitors
JWatch General 1998;1998:2-2.
FULL TEXT