AIDSWEEKLY Plus; Monday, April 17, 2000
Prepared by AIDS Weekly editors from staff and other reports

Investigators from the CASCADE Collaboration (the Concerted Action on SeroConversion to AIDS and Death in Europe) compared survival from seroconversion (the development of specific antibodies in the serum as a result of HIV-1 infection) among people at risk during 1986-96 (pre-HAART period) with those at risk in 1997-98 (HAART period) by use of pooled data on 5,646 seroconverters from 17 populations in 10 European countries. HIV-1 exposure was through various routes including sex between men, injecting drug use, sex between men and women, and hemophilia.

Overall, just over a quarter of the population had died. However, the risk of death was 64% lower in 1997-98 (after the introduction of HAART), compared with 1986-96.

Kholoud Porter, the study coordinator, comments: "Our findings show a large improvement in survival expectations in all age groups for those at risk during the period in which HAART became available. The continued long-term monitoring of seroconverters is crucial to assess whether the benefits from HAART are sustained because to date the follow-up period after its introduction is very short. Furthermore, the use of antiretroviral therapy closer to seroconversion, particularly for those diagnosed during acute infection, has unknown long-term implications."

Another study published in the same issue of The Lancet used data - before the introduction of HAART - from Europe, North America, and Australia to assess the effect of exposure category on the AIDS incubation period and survival and whether the effect of age at seroconversion varies with exposure category and with time since seroconversion.

An international research team, the Collaborative Group on AIDS Incubation and HIV Survival, found that mortality and AIDS incidence increased strongly with time since, and age at, seroconversion. Average survival varied from 12.5 years for those aged 15-24 years at seroconversion to 7.9 years for those aged 45-54 years at seroconversion. For the time to development of AIDS the corresponding values were 11 years and 7.7 years, respectively. Among people aged 25-29 years at seroconversion, it was estimated that 90% and 60% would survive to five years and 10 years after seroconversion, respectively.

The investigators conclude that time since seroconversion, and age at seroconversion, were the major determinants of survival and development of AIDS in Europe, North America, and Australia before the introduction of HAART in 1996.

This article was prepared by AIDS Weekly editors from staff and other reports.

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