A novel use of AIDS surveillance data to assess the impact of initial treatment regimen on survival

Abstract

The expense in time and money limit the use of randomized clinical trials (RCT) and cohort studies for evaluating long-term AIDS treatment outcomes. We conducted a case-control study to characterize predictors of AIDS mortality after the availability of highly active antiretroviral therapy (HAART) in San Francisco, in which cases were matched with controls on stage of disease, year of AIDS diagnosis and year of HAART initiation. Overall, 266 cases and 1173 controls were included, representing >90% of eligible patients. The class of initial HAART regimen was not associated with mortality. Predictors of mortality were older age ([adjusted odds ratio] AOR 1.23, 95% [confidence interval] CI: 1.13-1.35), public versus private health insurance (AOR 2.80, 95% CI: 1.77-4.42), no versus private insurance (AOR 1.45, 95% CI: 1.02-2.07) and unboosted saquinavir (AOR 2.50, 95% CI: 1.34-4.65). Survival benefit was found in following the 2004 US Department of Health and Human Services preferred treatment guidelines; borderline survival benefits were found in following the guidelines from other years. Similar predictors were found for all-cause and AIDS-specific mortality. Our findings mirrored those of RCT and multi-centre cohort studies, and may be applicable to other settings. Our findings support similar survival benefit to persons initiating HAART with non-nucleoside reverse transcriptase inhibitor- or protease inhibitor-based regimens.