Effects of the introduction of highly active antiretroviral therapy (HAART) on the temporal trend of diagnosis of AIDS and AIDS-defining disorders

Objectives: to assess the features of AIDS and AIDS-defining events during the highly active antiretroviral therapy (HAART) era, compared with those observed before the introduction of HAART.

Methods: the epidemiological, clinical and laboratory characteristics of 72 consecutive patients with AIDS diagnosed from 1997 to 1999, were compared to those of 144 subjects randomly selected from 436 AIDS patients diagnosed from 1985 and 1995, in a case control study.

Results: a sharp drop in AIDS notifications was observed after the introduction of HAART, in association with an increase in mean patient age, and heterosexual transmission of HIV infection. A tendency to reduced frequency of Cytomegalovirus disease, cryptococcosis, mycobacteriosis, cryptosporidiosis and HIV encephalopathy was also noticed, with a slight proportion increase in pneumocystosis, esophageal candidiasis, wasting syndrome, tuberculosis and lymphoma. Non-infectious complications showed a slighly increased frequency during the HAART era, while a mild parallel decrease in overall opportunistic infections was observed. A considerable trend to an increased mean CD4+ lymphocyte count at diagnosis was found during the HAART era for most AIDS-related illnesses (significant for Candida esophagitis, wasting syndrome and tuberculosis) (p<.04). Only seven of the 72 patients with AIDS recognized since 1997 received HAART prior to diagnosis, while the remaining 65 cases HIV infection was detected concurrently with an AIDS-defining event (40 cases), or HAART was refused or carried out with poor adherence (25 patients)

Conclusions: although remarkable changes of AIDS features of AIDS occurred after the widespread use of HAART, early diagnosis and treatment of HIV infection, and careful monitoring of the spectrum of AIDS-related diseases are strongly warranted in order to update and plan future management strategies.