Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the multicenter AIDS cohort study: 1985-1991

Alvaro Muñoz, Lewis K. Schrager, Helena Bacellar, Ilene Speizer, Sten H. Vermund, Roger Detels, Alfred J. Saah, Lawrence A. Kingsley, Daniela Seminara, John P. Phair

Research output: Contribution to journalArticlepeer-review

Abstract

Incidence of clinical outcomes defining acquired immunodeficiency syndrome (AIDS) may be expected to change as a consequence of progressive immunosuppression and use of chemoprophylaxis before the onset of AIDS. Using Poisson regression methods, we examined trends in the incidence of initial and secondary AIDS-defining illnesses from 1985 to 1991 among 2,627 homosexual men participating in the Multicenter AIDS Cohort Study who were seropositive for human immunodeficiency virus type 1. The incidence of Pneumocystis carinii pneumonia rose steeply until 1987 but has declined since then (P < 0.001), while the other AIDS-defining conditions have showed significant (P ≤ 0.039) upward trends. Trends for Kaposi's sarcoma, lymphoma, neurologic disease, and cytomegalovirus/herpes simplex virus infections were explained by progressive immunosuppression, but residual downward and upward trends were present for P. carinii pneumonia and other opportunistic infections (bacterial, fungal, and protozoal infections and wasting syndrome). Despite selection bias, those receiving P. carinii pneumonia chemoprophylaxis showed a significantly lower incidence of P. carinii pneumonia (relative risk = 0.32, 95% confidence interval 0.16-0.63), and the time trends of P. carinii pneumonia were explained by progressive immunosuppression and use of prophylaxis. No significant effects on all other diagnoses were seen in those selected to receive antiretroviral therapy. Secondary diagnoses showed a strongly significant (P < 0.001) increase in non-P. carinii pneumonia and non-Kaposi's sarcoma among those with initial diagnoses of Kaposi's sarcoma. Overall, the trend observed in the incidence of other opportunistic infections underscores the need for developing and testing new strategies to curtail or delay the onset of these diseases.

Original languageEnglish (US)
Pages (from-to)423-438
Number of pages16
JournalAmerican journal of epidemiology
Volume137
Issue number4
DOIs
StatePublished - Feb 15 1993

Keywords

  • Acquired immunodeficiency syndrome, epidemiologic methods
  • HIV-1
  • Lymphoma
  • Nervous system diseases, opportunistic infections
  • Pneumonia, Pneumocystis carinii
  • Sarcoma, Kaposi's

ASJC Scopus subject areas

  • Epidemiology

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