Changing patterns of mortality across Europe in patients infected with HIV-1

Background The introduction of combination antiretroviral therapy and protease inhibitors has led to reports of falling mortality rates among people infected with HIV-1. We examined the change in these mortality rates of HIV-1-infected patients across Europe during 1994-98, and assessed the extent to which changes can be explained by the use of new therapeutic regimens. Methods We analysed data from EuroSIDA, which is a prospective, observational, European, multicentre cohort of 4270 HIV-1-infected patients. We compared death rates in each 6 month period from September, 1994, to March, 1998. Findings By March, 1998, 1215 patients had died. The mortality rate from March to September, 1995, was 23·3 deaths per 100 person-years of follow-up (95% Cl 20·6–26·0), and fell to 4·1 per 100 person-years of follow-up (2·3–5·9) between September, 1997, and March, 1998. From March to September, 1997, the death rate was 65·4 per 100 person-years of follow-up for those on no treatment, 7·5 per 100 person-years of follow-up for patients on dual therapy, and 3·4 per 100 person-years of follow-up for patients on triple-combination therapy. Compared with patients who were followed up from September, 1994, to March, 1995, patients seen between September, 1997, and March, 1998, had a relative hazard of death of 0·16 (0·08–0·32), which rose to 0·90 (0·50–1·64) after adjustment for treatment. Interpretation Death rates across Europe among patients infected with HIV-1 have been falling since September, 1995, and at the begining of 1998 were less than a fifth of their previous level. A large proportion of the reduction in mortality could be explained by new treatments or combinations of treatments.