Survival after AIDS diagnosis in Italy, 1999-2006: a population-based study

To provide survival estimates of Italian people with AIDS (PWA) in the highly active antiretroviral therapy era and to identify prognostic factors at diagnosis and illnesses present at death.

Longitudinal study with all-cause mortality as end point.

The vital status and illnesses present at death of the 9662 Italian PWA diagnosed from 1999 to 2005 were evaluated through a record linkage with the Italian mortality database. The survival was estimated through Kaplan-Meier method, whereas hazard ratios were computed to identify prognostic factors in the first 12 months or later.

80.6% of PWA survived 1 year, 75.2% 2 years, and 66.4% 5 years. Elevated death risks emerged among older individuals, injection drug users, and those with a CD4 cell count <200. Non-Hodgkin lymphoma at AIDS diagnosis was the strongest negative prognostic factor, particularly in the first 12 months after AIDS (hazard ratio = 9.2, for primary brain lymphoma). At death, non-AIDS-defining illnesses increased from 38.4% in 1999 to 56.9% in 2006, with non-AIDS-defining cancers rising from 3.7% to 8.7%.

Our study documented the prolonged survival of Italian PWA, the strong impact of non-Hodgkin lymphoma on mortality, and the increasing frequency of non-AIDS-defining illnesses at death.