The effects on survival of early treatment of human immunodeficiency virus infection

Neil M H Graham, Scott Zeger, Lawrence P. Park, Sten H. Vermund, Roger Detels, Charles R. Rinaldo, John P. Phair

Research output: Contribution to journalArticle

Abstract

Background. Zidovudine has been shown to prolong survival in patients with the acquired immunodeficiency syndrome (AIDS) and, in persons with human immunodeficiency virus (HIV) infection but not AIDS, to delay the progression to AIDS. However, it is still uncertain whether treatment before the development of AIDS prolongs survival. Methods. We analyzed data from a cohort of 2162 high-risk men who were already seropositive for HIV type 1 (HIV-1) and 406 men who seroconverted from October 1986 through April 1991. There were 306 deaths. The probabilities of death were compared among men at simi4 lar stages of disease who began zidovudine therapy before the diagnosis of AIDS and among those who did not. Relative risks of death were calculated for each of five initial disease states on the basis of CD4+ cell counts and clinical symptoms and signs appearing over follow-up periods of 6, 12, 18, and 24 months. Adjustments were also made for the use of prophylaxis against Pneumocystis carinii pneumonia (PCP). Results. After we controlled for CD4+ cell count and symptoms, the use of zidovudine with or without PCP prophylaxis before the development of AIDS significantly reduced mortality in all follow-up periods. The relative risks of death were 0.43 (95 percent confidence interval, 0.23 to 0.78) at 6 months, 0.54 (95 percent confidence interval, 0.38 to 0.78) at 12 months, 0.59 (95 percent confidence interval, 0.44 to 0.79) at 18 months, and 0.67 (95 percent confidence interval, 0.52 to 0.86) at 24 months. After we adjusted for the effects of PCP prophylaxis, zidovudine alone significantly reduced mortality at 6, 12, and 18 months (relative risks, 0.45, 0.59, and 0.70, respectively), but not at 24 months (relative risk, 0.81). Among zidovu-dine users, those who also used PCP prophylaxis before the development of AIDS had significantly lower mortality at 18 and 24 months than those who did not (relative risks, 0.62 and 0.60, respectively). Conclusions. The results of this study support the hypothesis that in HIV-1 infection, early treatment with zidovudine and PCP prophylaxis improves survival in addition to slowing the progression to AIDS.

Original languageEnglish (US)
Pages (from-to)1037-1042
Number of pages6
JournalNew England Journal of Medicine
Volume326
Issue number16
StatePublished - Apr 16 1992

Fingerprint

Virus Diseases
Acquired Immunodeficiency Syndrome
Pneumocystis Pneumonia
Zidovudine
HIV
Survival
Confidence Intervals
Therapeutics
CD4 Lymphocyte Count
Mortality
HIV-1
Signs and Symptoms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Graham, N. M. H., Zeger, S., Park, L. P., Vermund, S. H., Detels, R., Rinaldo, C. R., & Phair, J. P. (1992). The effects on survival of early treatment of human immunodeficiency virus infection. New England Journal of Medicine, 326(16), 1037-1042.

The effects on survival of early treatment of human immunodeficiency virus infection. / Graham, Neil M H; Zeger, Scott; Park, Lawrence P.; Vermund, Sten H.; Detels, Roger; Rinaldo, Charles R.; Phair, John P.

In: New England Journal of Medicine, Vol. 326, No. 16, 16.04.1992, p. 1037-1042.

Research output: Contribution to journalArticle

Graham, NMH, Zeger, S, Park, LP, Vermund, SH, Detels, R, Rinaldo, CR & Phair, JP 1992, 'The effects on survival of early treatment of human immunodeficiency virus infection', New England Journal of Medicine, vol. 326, no. 16, pp. 1037-1042.
Graham NMH, Zeger S, Park LP, Vermund SH, Detels R, Rinaldo CR et al. The effects on survival of early treatment of human immunodeficiency virus infection. New England Journal of Medicine. 1992 Apr 16;326(16):1037-1042.
Graham, Neil M H ; Zeger, Scott ; Park, Lawrence P. ; Vermund, Sten H. ; Detels, Roger ; Rinaldo, Charles R. ; Phair, John P. / The effects on survival of early treatment of human immunodeficiency virus infection. In: New England Journal of Medicine. 1992 ; Vol. 326, No. 16. pp. 1037-1042.
@article{4dbee200916648c5bf3899d6ea024b03,
title = "The effects on survival of early treatment of human immunodeficiency virus infection",
abstract = "Background. Zidovudine has been shown to prolong survival in patients with the acquired immunodeficiency syndrome (AIDS) and, in persons with human immunodeficiency virus (HIV) infection but not AIDS, to delay the progression to AIDS. However, it is still uncertain whether treatment before the development of AIDS prolongs survival. Methods. We analyzed data from a cohort of 2162 high-risk men who were already seropositive for HIV type 1 (HIV-1) and 406 men who seroconverted from October 1986 through April 1991. There were 306 deaths. The probabilities of death were compared among men at simi4 lar stages of disease who began zidovudine therapy before the diagnosis of AIDS and among those who did not. Relative risks of death were calculated for each of five initial disease states on the basis of CD4+ cell counts and clinical symptoms and signs appearing over follow-up periods of 6, 12, 18, and 24 months. Adjustments were also made for the use of prophylaxis against Pneumocystis carinii pneumonia (PCP). Results. After we controlled for CD4+ cell count and symptoms, the use of zidovudine with or without PCP prophylaxis before the development of AIDS significantly reduced mortality in all follow-up periods. The relative risks of death were 0.43 (95 percent confidence interval, 0.23 to 0.78) at 6 months, 0.54 (95 percent confidence interval, 0.38 to 0.78) at 12 months, 0.59 (95 percent confidence interval, 0.44 to 0.79) at 18 months, and 0.67 (95 percent confidence interval, 0.52 to 0.86) at 24 months. After we adjusted for the effects of PCP prophylaxis, zidovudine alone significantly reduced mortality at 6, 12, and 18 months (relative risks, 0.45, 0.59, and 0.70, respectively), but not at 24 months (relative risk, 0.81). Among zidovu-dine users, those who also used PCP prophylaxis before the development of AIDS had significantly lower mortality at 18 and 24 months than those who did not (relative risks, 0.62 and 0.60, respectively). Conclusions. The results of this study support the hypothesis that in HIV-1 infection, early treatment with zidovudine and PCP prophylaxis improves survival in addition to slowing the progression to AIDS.",
author = "Graham, {Neil M H} and Scott Zeger and Park, {Lawrence P.} and Vermund, {Sten H.} and Roger Detels and Rinaldo, {Charles R.} and Phair, {John P.}",
year = "1992",
month = "4",
day = "16",
language = "English (US)",
volume = "326",
pages = "1037--1042",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "16",

}

TY - JOUR

T1 - The effects on survival of early treatment of human immunodeficiency virus infection

AU - Graham, Neil M H

AU - Zeger, Scott

AU - Park, Lawrence P.

AU - Vermund, Sten H.

AU - Detels, Roger

AU - Rinaldo, Charles R.

AU - Phair, John P.

PY - 1992/4/16

Y1 - 1992/4/16

N2 - Background. Zidovudine has been shown to prolong survival in patients with the acquired immunodeficiency syndrome (AIDS) and, in persons with human immunodeficiency virus (HIV) infection but not AIDS, to delay the progression to AIDS. However, it is still uncertain whether treatment before the development of AIDS prolongs survival. Methods. We analyzed data from a cohort of 2162 high-risk men who were already seropositive for HIV type 1 (HIV-1) and 406 men who seroconverted from October 1986 through April 1991. There were 306 deaths. The probabilities of death were compared among men at simi4 lar stages of disease who began zidovudine therapy before the diagnosis of AIDS and among those who did not. Relative risks of death were calculated for each of five initial disease states on the basis of CD4+ cell counts and clinical symptoms and signs appearing over follow-up periods of 6, 12, 18, and 24 months. Adjustments were also made for the use of prophylaxis against Pneumocystis carinii pneumonia (PCP). Results. After we controlled for CD4+ cell count and symptoms, the use of zidovudine with or without PCP prophylaxis before the development of AIDS significantly reduced mortality in all follow-up periods. The relative risks of death were 0.43 (95 percent confidence interval, 0.23 to 0.78) at 6 months, 0.54 (95 percent confidence interval, 0.38 to 0.78) at 12 months, 0.59 (95 percent confidence interval, 0.44 to 0.79) at 18 months, and 0.67 (95 percent confidence interval, 0.52 to 0.86) at 24 months. After we adjusted for the effects of PCP prophylaxis, zidovudine alone significantly reduced mortality at 6, 12, and 18 months (relative risks, 0.45, 0.59, and 0.70, respectively), but not at 24 months (relative risk, 0.81). Among zidovu-dine users, those who also used PCP prophylaxis before the development of AIDS had significantly lower mortality at 18 and 24 months than those who did not (relative risks, 0.62 and 0.60, respectively). Conclusions. The results of this study support the hypothesis that in HIV-1 infection, early treatment with zidovudine and PCP prophylaxis improves survival in addition to slowing the progression to AIDS.

AB - Background. Zidovudine has been shown to prolong survival in patients with the acquired immunodeficiency syndrome (AIDS) and, in persons with human immunodeficiency virus (HIV) infection but not AIDS, to delay the progression to AIDS. However, it is still uncertain whether treatment before the development of AIDS prolongs survival. Methods. We analyzed data from a cohort of 2162 high-risk men who were already seropositive for HIV type 1 (HIV-1) and 406 men who seroconverted from October 1986 through April 1991. There were 306 deaths. The probabilities of death were compared among men at simi4 lar stages of disease who began zidovudine therapy before the diagnosis of AIDS and among those who did not. Relative risks of death were calculated for each of five initial disease states on the basis of CD4+ cell counts and clinical symptoms and signs appearing over follow-up periods of 6, 12, 18, and 24 months. Adjustments were also made for the use of prophylaxis against Pneumocystis carinii pneumonia (PCP). Results. After we controlled for CD4+ cell count and symptoms, the use of zidovudine with or without PCP prophylaxis before the development of AIDS significantly reduced mortality in all follow-up periods. The relative risks of death were 0.43 (95 percent confidence interval, 0.23 to 0.78) at 6 months, 0.54 (95 percent confidence interval, 0.38 to 0.78) at 12 months, 0.59 (95 percent confidence interval, 0.44 to 0.79) at 18 months, and 0.67 (95 percent confidence interval, 0.52 to 0.86) at 24 months. After we adjusted for the effects of PCP prophylaxis, zidovudine alone significantly reduced mortality at 6, 12, and 18 months (relative risks, 0.45, 0.59, and 0.70, respectively), but not at 24 months (relative risk, 0.81). Among zidovu-dine users, those who also used PCP prophylaxis before the development of AIDS had significantly lower mortality at 18 and 24 months than those who did not (relative risks, 0.62 and 0.60, respectively). Conclusions. The results of this study support the hypothesis that in HIV-1 infection, early treatment with zidovudine and PCP prophylaxis improves survival in addition to slowing the progression to AIDS.

UR - http://www.scopus.com/inward/record.url?scp=0026557478&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026557478&partnerID=8YFLogxK

M3 - Article

C2 - 1347907

AN - SCOPUS:0026557478

VL - 326

SP - 1037

EP - 1042

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 16

ER -