Survival after diagnosis of AIDS: a prospective observational study of 2625 patients

Abstract

Objective: To estimate median survival and changes in survival in patients diagnosed as having AIDS. Design: Prospective observational study. Setting: Clinics in two large London hospitals. Subjects: 2625 patients with AIDS seen between 1982 and July 1995. Main outcome measures: Survival, estimated using lifetable analyses, and factors associated with survival, identified from Cox proportional hazards models. Results: Median survival (20 months) was longer than previous estimates. The CD4 lymphocyte count at or before initial AIDS defining illness decreased significantly over time from 90x10⁶/l during 1987 or earlier to 40x10⁶/l during 1994 and 1995 (PPneumocystis carinii pneumonia (0.21 (0.07 to 0.59), P=0.0030 and 0.37 (0.16 to 0.83), P=0.016). Three months after AIDS diagnosis, the risk of death was similar in patients whose diagnosis was made after and before 1987 (1.02 (0.79 to 1.31), P=0.91). There were no differences in survival between patients diagnosed during 1988-90, 1991-3, or 1994-5. Conclusions: In later years, patients were much more likely to survive their initial illness, but long term survival has remained poor. The decrease in CD4 lymphocyte count at AIDS diagnosis indicates that patients are being diagnosed as having AIDS at ever more advanced stages of immunodeficiency. Estimates of the prognosis of AIDS patients help with allocation of resources and future research Historically, surveillance data have been used to estimate survival in large patient groups In an unselected group of 2625 patients with AIDS, median survival (20 months) was longer than previously estimated; the CD4 count at diagnosis decreased significantly over time After 1987, patients were much more likely to survive an initial AIDS defining illness, but long term prognosis remained poor There has been little change in prognosis since 1987; this may be due to AIDS being diagnosed at ever more advanced stages of immunodeficiency