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AIDS-Related Opportunistic Illness and Potent Antiretroviral Therapy
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To the Editor: Dr Ledergerber and colleagues1 presented data on the incidence of opportunistic infections and cancers in human immunodeficiency virus (HIV)–infected persons. They compared the incidence of specific illnesses in the 6-month period before potent antiretroviral therapy with the incidence in periods after initiation of therapy, and concluded that a decreased incidence of some (but not all) illnesses indicated an effect of therapy. However, analytic difficulties complicate interpretation of these trends for individual opportunistic illnesses.
Pretherapy incidence rates are not strictly comparable with posttherapy rates. Unlike posttherapy rates, pretherapy rates are calculated retrospectively for a group known to be alive at the end of the pretherapy period. These conditional incidence rates are too low for illnesses with a high mortality rate because some affected persons do not survive to start therapy. The effect of therapy is then underestimated if these low rates are included in trend tests. For example, . . . [Full Text of this Article]
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JAMA. 1999;282(23):2220-2226.
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