Room to improve treatments, study finds

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Although treatment advances have dramatically reduced deaths from opportunistic infections related to Aids, a new study drawing on 30 years of data from more than 20,000 patients in San Francisco suggests there is still ample room to improve. About a third – 35% – of Aids patients diagnosed with their first opportunistic infection from 1997 to 2012 in that city died within five years, according to the study.

“While recent research suggests that many opportunistic infections in the US are now less common and, oftentimes, less lethal, we cannot forget about them,” said Dr Kpandja Djawe, of the Centres for Disease Control and Prevention (CDC) and the lead author of the study, which included researchers from CDC and the San Francisco Department of Public Health. “We need to keep them in mind, even in the context of the changing epidemiology of HIV.”

For the study, researchers analysed HIV surveillance data collected continuously over the past 30-plus years by the San Francisco Department of Public Health on initial and subsequent Aids-defining opportunistic infections, citywide, beginning in 1981. These were common during the early years of the US epidemic, when death often quickly followed an Aids diagnosis: From 1981 to 1986, only 7% of patients in San Francisco diagnosed with their first opportunistic infection lived more than five years, according to the study.

Since then, with advances in antiretroviral therapy (ART), wider availability of HIV testing, and improvements in the treatment of opportunistic illnesses, survival rates have markedly risen. During the most recent period analysed in the study (1997 to 2012), 65% of patients diagnosed with an Aids-related opportunistic infection lived five more years or longer, a trend consistent with other studies.

The remaining 35% of Aids patients – those who died within five years of being diagnosed with an opportunistic infection – underscore the work still to be done to address Aids-related illnesses today, the authors noted. 2Better prevention and treatment strategies, including earlier HIV diagnosis, are needed to lessen the burden of Aids opportunistic infections, even today, in the combination ART era,” said Dr Sandra Schwarcz, senior HIV epidemiologist at the San Francisco Department of Public Health and one of the authors of the study.

Indeed, some of these infections, such as progressive multifocal leukoencephalopathy (PML), and infection-related cancers, including brain lymphoma, remain associated with substantial mortality risk today, the authors found, despite an overall improvement in survival rates. In addition, the health outcomes in San Francisco may be more favourable than in some other parts of the country, where HIV testing and treatment programmes may be less robust.

 

“The results from San Francisco are encouraging, but highlight the need to remain focused on the potential for opportunistic infections to cause devastating disease,” Dr Henry Masur and Dr Sarah W Read of the National Institutes of Health, noted in a related editorial commentary. “A 35% mortality rate within five years of the initial Aids-defining opportunistic infection leaves considerable room for improvement.”

Infectious Diseases Society of America material
Journal of Infectious Diseases abstract 1
Journal of Infectious Diseases abstract 2


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