The Body Covers: The 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
AIDS Opportunistic Infections (OI)-Related Deaths in the Era of HAART
September 28, 2002
The study utilized patient data from 185 French hospitals, following approximately 65,000 people with HIV. Nine hundred and sixty six deaths occurred during the calendar year 2000, and data were available on 923 of the cases. In 262 cases, the deaths were felt to be exclusively from opportunistic infections; the most common were cytomegalovirus (CMV, 67 cases), Pneumocystis carinii pneumonia (PCP, 56), M. avium (53), toxoplasmosis (47), progressive multifocal leukoencephalopathy (PML, 42), and tuberculosis (47). As in the pre-combination antiretroviral therapy era, most of the deaths occurred with severe immunodeficiency; the average CD4 cell count was less than 50 in 71 percent of the patients who died (average 16), and the average viral load was 126,000.
Not surprisingly, the factors associated with an opportunistic infection as the cause of death were proxies for presenting late in HIV disease and non-receipt of antiretroviral therapy. They included poor socioeconomic status, more recent HIV diagnosis, being antiretroviral therapy-naive, and having been foreign-born.
The study's results are not surprising, but they serve as a reminder that the benefits of antiretroviral therapy can only be accrued if people have access to these medications. In an industrialized country such as France, extra efforts should be made to increase such access to those who may not be engaged in or reluctant to seek care. In addition, they highlight the continued benefit of therapy for those who do receive it, as there were few opportunistic infection-related deaths in those on antiretroviral therapy.
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