A decade after the introduction of highly active antiretroviral therapy (HAART) for HIV infection in Europe and North America, the risk of AIDS and death remains low for those starting treatment, according to a study in this week’s issue of The Lancet.

HAART is a combination of several antiretroviral agents that has been highly effective in improving AIDS-free survival. To investigate whether the prognosis for patients taking HAART has changed over time, Margaret May (University of Bristol, UK) and colleagues analysed data from over 22 200 HIV infected patients in Europe and North America who had started HAART for the first time between 1995 and 2003. The investigators found that although patients’ control of the HIV virus improved over the years, their risk of death in the first year after starting treatment has remained approximately the same. There was evidence that the risk of AIDS in patients starting HAART has increased since 1998. The researchers found that this was largely attributable to an increase in TB.

The authors’ comment: “The discrepancy between the clear improvement we recorded for the action of the drugs in keeping the HIV virus in check and the apparently worsening rates of clinical progression might be related to the change in demographic characteristics of the study participants, with an increasing number of patients from areas with a high incidence of tuberculosis.”

The investigators also found that many patients had started HAART at a more advanced stage of HIV disease than is recommended by treatment guidelines. They conclude: “Early diagnosis and treatment of those with HIV-infection is needed to prevent progression to AIDS. An expansion of voluntary and cost-effective screening in health-care settings is likely to result in improved patient care and prognosis.”

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