Huge AIDS improvements since the 80s - but infections 'remain a problem'

Being diagnosed with AIDS in the early 1980s often meant a prognosis of death within a year because of the opportunistic illnesses that define the syndrome, such as a certain infection that leads to pneumonia. While a large study has found marked improvements in survival thanks to the era of HIV drug treatment, "better prevention and treatment strategies are still needed" for AIDS-related illness.

Advances against HIV mean many more years of life before AIDS develops, but the study shows it is by no means history.

The study, published in The Journal of Infectious Diseases, draws on 30 years of data from more than 20,000 patients in San Francisco, CA.

Although treatment advances have dramatically reduced deaths from opportunistic infections related to AIDS, the study finds that about a third of AIDS patients in the city diagnosed with their first opportunistic infection from 1997 to 2012 died within 5 years.

Untreated HIV infection progresses to AIDS, opportunistic infections and cancers, so antiviral developments have improved prospects, as has better testing.

From 1981 (the start of this surveillance study) to 1986 - the early years of the US epidemic - 7% of patients in San Francisco diagnosed with their first opportunistic infection lived more than 5 years, the findings show.

But between 1997 and 2012, 65% of patients diagnosed with an AIDS-related opportunistic infection lived 5 more years or more.

"While recent research suggests that many opportunistic infections in the US are now less common and, oftentimes, less lethal, we cannot forget about them.

We need to keep them in mind, even in the context of the changing epidemiology of HIV."

35% of AIDS patients still die in the 5 years after infection

An editorial in the same issue of the journal paints the picture of the epidemic in the early days:

In the eras when no antiretroviral therapy (ART) was available or when ART was limited to single or dual nucleoside agents, median survival times after the diagnosis of the first AIDS-associated opportunistic infection were very limited, ranging from 2 to 22 months, depending on the infection.

Written by Dr. Henry Masur and Dr. Sarah Read, both of the US National Institutes of Health in Bethesda, MD, the article explains that, due to a lack of HIV testing, the first most patients knew about their status was after "they presented to health care providers with an opportunistic infection."

But while the picture today is markedly improved, there is still, as the title of the editorial puts it, room for improvement.

The 65% of patients now living beyond 5 years after getting an AIDS infection are only part of the story - there is the remaining 35% dying within this time.

As a matter of fact, better 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.

But there is a fundamental need to remain focused on the potential for opportunistic infections to cause devastating disease.

The infections that the authors have found remain associated with substantial death risk today include progressive multifocal leukoencephalopathy (PML) and infection-related cancers, including brain lymphoma.

References:

1.  Mortality risk after AIDS-defining opportunistic illness among HIV-infected persons - San Francisco, 1981-2012, Kpandja Djawe et al., The Journal of Infectious Diseases, doi: 10.1093/infdis/jiv235, published online 3 June 2015.
2.  Opportunistic infections and mortality: still room for improvement, Henry Masur and Sarah Read, The Journal of Infectious Diseases, doi: 10.1093/infdis/jiv236, published online 3 June 2015.