Survival rates in NYC in the era of combination ART

Since the advent of combined antiretroviral therapy in 1996, substantial decreases in HIV-related morbidity and mortality have been observed in the United States and other developed countries. To assess the effects on overall survival and for specific AIDS-defining illnesses (ADIs), survival among persons with AIDS (PWAs) in New York City (NYC) before and after the introduction of combination therapy was investigated.

Survival among 79,878 PWAs diagnosed between 1990 and 1998 and reported through March 2001 was estimated. Cumulative survival at 24 months among PWAs was estimated by actuarial methods, and Cox proportional hazards model adjusted for covariates was used to estimate the relative hazard (RH) of death for specific ADIs over time.

Overall cumulative survival at 24 months increased from 43% among PWAs diagnosed during 1990-1995 to 76% for those diagnosed 1996-1998. Improving survival for all ADIs was found among PWAs diagnosed after 1995, but changes for immunoblastic lymphoma, primary lymphoma of the brain, and invasive cervical cancer were only moderate and were statistically (p >.05) insignificant. Burkitt lymphoma, immunoblastic lymphoma, invasive cervical cancer, and primary lymphoma of the brain had the highest RH of death among PWAs diagnosed after 1995.

Substantial improvements in survival after 1995 were found for all PWAs but varied by gender, race, risk, socioeconomic status, and specific ADIs. Consistent with other studies, neoplastic ADIs have shown less improvement than other diseases after 1995. The relatively poor outcome of PWAs with neoplastic diseases requires further investigation.