By 2004, patients who were infected via sexual contact, and whose infections were caught early, were no more likely to die in the first five years after their diagnosis than similarly-aged, non-HIV infected people, according to a study published Tuesday in the Journal of the American Medical Association.
"We weren't surprised about the dramatic decline [in mortality] over time," said Kholoud Porter, an epidemiologist at the Medical Research Council Clinical Trials Unit in London. "But this puts a number on it."
Indeed, past studies had already found dramatic declines in HIV death rates since the mid 1990s, but this is the first to compare those rates to mortality rates in the general population, according to the researchers.
Porter and her colleagues examined data from a long-term, multinational study of more than 16,500 HIV patients in Europe, Canada and Australia. The patients were recruited for the study because they were tested regularly for the virus and so knew within about a year when they were infected.
The data included patients followed between 1981 and 2006. The researchers compared the rate at which these patients died to the average mortality rate expected in a similarly-aged population from those countries.
They found that before 1996, when antiretrovirals were introduced, HIV patients who had been infected through sexual contact had an 8 to 23 percent chance of dying within five years of their diagnosis, depending on their age. By 1998 to 1999, that chance had dropped to 3 to 12 percent. By 2004 to 2006, it was 0 to 5 percent -- no different than the population as a whole.
They were still more likely to die in the longer term -- over 5 to fifteen years -- although that risk dropped dramatically as well.
All HIV patient mortality rates declined over time, but injection drug users and older patients had a relatively higher excess mortality rate compared to the general population than other patients in the study, and women had a lower excess mortality rate than men.
"What this article does is show how effective HAART (highly active antiretroviral therapy) is," said Alvaro Munoz, an epidemiologist at Johns Hopkins University who was not involved in this research, but who has found similar drops in mortality rates among HIV-positive injection drug users. "What this indicates is how imperative it is to make these therapies available to more people."
Study author Krishnan Bhaskaran, of Medical Research Council Clinical Trials Unit in London, said that the research also points to the importance of early diagnosis.
"People in our study had to know their date of infection, so by definition they were diagnosed early," Bhaskaran said. "They had the maximum opportunity for treatment at exactly the right point. This shows what's possible when people are diagnosed early."
