Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy

Background. The magnitude of the impact of highly active antiretroviral therapy (HAART) since its introduction in non-Western countries is not entirely clear. We studied disease progression among adult patients with advanced human immunodeficiency virus type 1 (HIV-1) infection in the pre-HAART (i.e., 1996 and earlier) and HAART eras in Hong Kong. Methods. The cohort of patients seen at the Integrated Treatment Center (Hong Kong) from 1984 through mid-2003 was retrospectively examined with respect to 3 clinical end points: death after the diagnosis of acquired immunodeficiency syndrome (AIDS), progression to AIDS after achieving a CD4 cell count of <200 cells/μL, and death after achieving a CD4 cell count of <200 cells/μL. Results. A total of 581 patients with advanced HIV-1 disease had AIDS and/or a CD4 cell count of <200 cells/μL. The incidences of death after AIDS (52.3% vs. 13.6%), AIDS progression after a CD4 cell count of <200 cells/μL (47.7% vs. 20.9%), and death after a CD4 cell count of <200 cells/μL (38.8% vs. 7.0%) were significantly higher among patients in the pre-HAART era than among those in the HAART era (P < .001 for all). On the basis of life-table analysis, the probabilities of death after AIDS (P < .0001), AIDS after a CD4 cell count of <200 cells/ μL (P = .0063), and death after a CD4 cell count of <200 cells/μL (P < .0001) diminished in the HAART era, compared with the pre-HAART era. Median survival after AIDS increased from 29.8 months during the preHAART era to >70 months during the HAART era (P < .001). Compared with patients in the pre-HAART era, adjusted hazard ratios of clinical events were 0.15 (95% confidence interval [CI], 0.08-0.26) for death after AIDS, 0.38 (95% CI, 0.24-0.60) for AIDS after a CD4 cell count of <200 cells/μL, and 0.25 (95% CI, 0.15-0.40) for death after a CD4 cell count of <200 cells/μL for patients in the HAART era. Conclusions. The clinical outcome of patients with advanced HIV-1 disease in Hong Kong significantly improved during the HAART era. Our findings of extended durations of survival and AIDS-free status may be relevant to the expected health impacts associated with increased access to HAART in non-Western countries.