End-Stage AIDS Patient Profile in US Has Changed Since HAART

Originally published by Reuters Health, March 15, 2002

NEW YORK (Reuters Health) — Since highly active antiretroviral therapy (HAART) was introduced, more patients who die of AIDS in the US are 35 years of age or older, injection drug users, and HAART-experienced. Other changes have included declines in the prevalence of some opportunistic infections and an increase in renal and hepatic diseases.

Dr. Kathleen Welch, of the HIV Outpatient Clinic in New Orleans, and associates from the US Centers for Disease Control and Prevention in Atlanta, compared recent clinical profiles of end-stage AIDS with patient profiles prior to the advent of HAART.

The researchers used information from the CDC Adult Spectrum of Disease database for 669 HIV-infected patients who died between 1996 and 2001. Prior to their death, the patients had been treated at a large public HIV primary care clinic.

As reported in the February issue of AIDS Patient Care and STDs, 78.2% of the cohort was male, and the mean age at death was 40 years old. Nearly 60% had been prescribed HAART.

Median CD4 cell count for the end-stage conditions did not change significantly in the HAART era. The researchers noted a "decline in MAC, CMV infection, and toxoplasmosis but not in other neurologic conditions and AIDS-associated lymphomas." Since HAART, more than a third of AIDS patients had either renal disease or hepatitis B or C, an increasing cause of mortality.

Dr. Welch and her colleagues hope that clinicians will use such profiles to better estimate the appropriate time to discuss end-of-life options, such as hospice care, and improve AIDS patients' quality of life.