The risk of AIDS and death still remains low for those starting treatment, ten years after introducing the highly active antiretroviral therapy (HAART) in Europe and North America.

Researchers from the University of Bristol, the co-ordinating centre for  the Antiretroviral Therapy Cohort Collaboration, reveal the results of their study in this week’s issue of The Lancet.

HAART, which was introduced a decade ago for the treatment of HIV infection, has resulted in 80% to 90% reductions in rates of AIDS and death compared with patients who are not treated. To investigate whether the prognosis for patients taking this therapy has changed over time, Dr Margaret May and colleagues analysed data from over 22,200 HIV infected patients in Europe and North America.

The patients had started HAART for the first time in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. 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 has increased since 1998. The researchers found that this was largely attributable to an increase in tuberculosis.

Dr Margaret May, from the University of Bristol, comments: “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 researchers also found that many patients had started HAART at a more advanced stage of HIV disease than is recommended by treatment guidelines. Professor Matthias Egger states: “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.”