Death rates of 60% of people infected by the virus that causes AIDS equals that of the general population
- The Institute for AIDS Research IrsiCaixa, funded by “la Caixa” Foundation and the Health Department of the Generalitat de Catalunya, has participated in an international research project showing that patients with a well-controlled HIV infection have the same mortality risk as the general population.
- A well-controlled HIV infection means a good response to the antiretroviral treatment, very low quantity of HIV in blood and a normal level of immune function. In the case of the Hospital Germans Trias i Pujol, 60% of patients meets these conditions.
- Researchers highlight that much of the excess mortality associated with HIV could be preventable with timely diagnosis and initiation of the treatment with antiretrovirals.
- The results, published today in the scientific journal AIDS, emphasize the need to promote the HIV test among the population as a mean to increase their life expectancy and at the same time prevent the infection being spread, as it is known that 25% of the infected people do not know it.
Since in 1981 were detected hte first cases of infection by the virus that causes AIDS, HIV, treatments have evolved and improved, becoming simpler, less toxic and more effective. Through decades of research, and despite we do not have a cure for HIV infection yet, antiretroviral therapy (ART) has demonstrated a high level of success and the different drugs available today have contributed to increase both life expectancy and quality of life in HIV-infected people.
New results published today online in the scientific journal AIDS provide the best evidence yet that people with HIV who achieved good disease control under antiretroviral treatment and a recovery of their immune system have essentially the same mortality rate as the general population. A well-controlled HIV infection means a good response to the antiretroviral treatment, very low quantity of HIV in blood and a normal level of immune function. The study has been conducted by the Institute for AIDS Research IrsiCaixa, funded by “la Caixa” Foundation and the Health Department of the Generalitat de Catalunya, together with other international research institutions led by the researcher from the University College of London Alison Rodger.
According to the IrsiCaixa researcher MD Roger Paredes, “about a 60% of patients of the Hospital Germans Trias i Pujol in Badalona, Barcelona”, where Paredes also forms part of its HIV Unit, “have managed to maintain or to recover their immune system with the treatment and therefore have the same mortality rate as the general population”.
“It is likely that much of the excess mortality associated with HIV would be preventable with timely diagnosis of HIV and initiation of ART, together with a good patient monitoring to gain adherence to treatment”, concludes Bonaventura Clotet, director of IrsiCaixa. However, he also highlights that it is not enough, and reminds that “there is always a reduced group of patients, between 10% and 15%, that, despite efforts, will not achieve a good level of immune function. We are trying to develop new strategies, and for that we need more investment in both basic and clinical research”.
A large international project
Researchers have compared mortality rates and causes of death in well-controlled HIV-infected adults with the general population mortality data. With this aim, they carried out a broad analysis of nearly 3.300 optimally treated patients from two major international clinical trials called SMART and ESPRIT. The study included patients on ART aged from 20 to 70 (20% women, 80% men), who were not injecting drug users, who had undetectable viral loads in blood and a number of the white cells called CD4, which are the ones targeted by the HIV, of more than 350 CD4+ cells in each mm3 of blood -while the normal level lies between 500 to 1.000 CD4+ cells/mm3. In Europe, more than 50% of HIV new diagnoses are below 350 CD4+ and in Africa, near 70%. However, in most of the cases, these levels can be raised if rapid access to treatment at early stage of infection is guaranteed.
During the follow-up period of about 3 years, 62 deaths occurred, but only 3% of deaths were related to AIDS. For the remaining 97% cases left, the commonest causes were cardiovascular disease and sudden death. “Mortality rate was increased compared with the general population only for those patients with a CD4+ level below 500 cells/mm3”, explains Roger Paredes.
In view of this data, scientists have concluded that in HIV-infected people on antiretroviral therapy, with a recent undetectable viral load, who maintained or had a recovery of CD4+ cell counts to at least 500 cells/mm3 -no matters if they had ever achieved lower levels-, they found no evidence for a raised risk of death compared with the general population. However, below those levels, mortality risk is still higher than in the general population.
As part of its research portfolio, IrsiCaixa has contributed to characterize the clinical and molecular epidemiology of HIV/AIDS in Europe, being involved in the main European and international HIV clinical epidemiology cohorts since its foundation 17 years ago. Currently, IrsiCaixa is an active member of the EU-funded EuroSIDA, EuroCOORD, and CHAIN cohorts, which characterize the clinical, virological and social determinants of health in thousands of HIV-infected individuals in Europe. This task is carried out in coordination with the Fundació Lluita contra la Sida and the Hospital Germans Trias i Pujol.
Read abstract online