• Mortality Rate Among Patients with Advanced HIV/AIDS Enrolled in the Abacavir Expanded Access Program
  Poster 2042
  Authored by M. L. Funk, A. D. White, A. Cutrell, J. Johnson, S. V. Hetherington

Expanded access programs in the U.S. allow HIV patients with few therapeutic options and advanced disease to benefit from new antiretroviral therapies. Although, in most cases, this intervention is not enough to cause a dramatic change in patient clinical course, it may allow the patient some extra time to benefit from other therapeutic interventions. This study was conducted to determine the life expectancy of patients with advanced HIV-1 disease receiving abacavir during the study period.

Over 2,500 patient were enrolled on the expanded access program between July 1997 and December 1998. Those patients had evidence of treatment failure or were intolerant to acceptable therapy. Their CD4 was <100 cells/mm³ and plasma HIV-1 RNA was >30,000. Patents received abacavir 300mg BID in combination with other drugs chosen by the investigator. Patients were followed every one to two months. Life expectancy was calculated based on the total amount of person-time since the first dose of abacavir and the total number of deaths.

The study found that the life expectancy for women was 5.7 years, whereas the life expectancy men was 7.7 years. Whites and African-Americans had a life expectancy of 7.2 years, whereas other ethnic and racial groups had a life expectancy of 12.8 years. Using a multivariate analysis, the author found that the stronger predictors of decreased life expectancy were CD4 cell count at pre-entry and the number of prior AIDS-defining illness at pre-entry. Life expectancy decreased by 21% for each halving of each CD4 cell count. Life expectancy also decreased by 28% for each prior or current AIDS-defining illness the patient reported at pre-entry. Plasma HIV-1 RNA, current ART, and number of prior ART were all not significantly independent predictors of shorter life expectancy. In addition, there was no difference in life expectancy between subjects older and younger than 50 years of age. The multivariate analysis suggested an increase in life expectancy of patients concurrently treated with protease inhibitors. Although in vitro studies suggest that ddI and ddC may have cross-resistance with abacavir, the prior or concurrent.