Bay Area Reporter - July 10, 2008
Bob Roehr

The Cascade Collaboration looked at data from 23 cohorts of patients in Europe, Canada, and Australia - 16,534 people in all - who were identified very early in their infection and followed during the period 1981 to 2006. The study was published in the July 1 edition of JAMA , the Journal of the American Medical Association.

The study found that introduction of highly active antiretroviral therapy (HAART) in the mid-1990s was the turning point. Since then newly infected persons have had the same rate of mortality over the next five years as the general population. That is not surprising given that only a small portion of infected persons are rapid progressors who would have died without therapy within five years.

After 10 years, the study projected a cumulative excess probability of death of 4.5 percent in those aged 15 to 24 years and 4.3 percent in those 45 years or older at the time of initial infection.

While the difference in life expectancy between infected and non-infected persons continued to shrink, the author concluded, "It is likely, that even with current standards of HIV management, some long-term excess mortality would remain because problems of toxicity, resistance, and therapy adherence are likely to increase with time receiving HAART."

The Centers for Disease Control and Prevention looked at 214,379 new HIV diagnoses in the 33 states that have had names reporting of data for 2001-2006. MSM were the only risk category that showed an increase during that time period, 8.6 percent overall or 1.5 percent a year. All of the other risk categories were flat or showed a decline.

Some 46 percent of new cases were among persons reporting MSM as a risk factor for acquiring HIV, while an additional 4 percent acknowledged both MSM and injection drug use as risks. Men aged 25-44 accounted for nearly two-thirds (63 percent) of the new diagnoses among MSM.

Black MSM continue to be disproportionately affected. During the study period, among those ages 13-24, more than twice as many black MSM as white MSM (7,658 versus 3,221) were diagnosed with HIV. However, this age group constituted about 5 percent of total diagnoses overall.

There are several caveats to the CDC study. It does not include data from 17 states that did not have names reporting in place from 2001 forward, and that includes the largest jurisdiction, California. Nor does the data say anything about when the person became infected with HIV, only when the diagnosis was made and reported.

Finally the study acknowledged, "since 1993, the proportion of HIV/AIDS cases reported to the CDC without any identified risk factor for HIV infection has been increasing." By 2006 it had reached 25 percent of the total number of cases reported.

The CDC used a "statistical adjustment" to assign those cases to one category or another, therefore, one shouldn't read too much into small percentage differences in risk categories.

The study appeared in the June 27 issue of the CDC publication Morbidity and Mortality Weekly Report.

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