Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study

doi:10.1136/bmj.328.7430.15

BMJ 2004;328:15 (3 January), doi:10.1136/bmj.328.7430.15

Paper

Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study

Jim Young, biostatistician¹, Sabina De Geest, professor of nursing³, Rebecca Spirig, senior research fellow³, Markus Flepp, reader in internal medicine⁴, Martin Rickenbach, epidemiologist⁵, Hansjakob Furrer, reader in internal medicine⁶, Enos Bernasconi, head of unit⁷, Bernard Hirschel, professor of infectious diseases⁸, Amalio Telenti, professor of infectious diseases⁹, Pietro Vernazza, reader in internal medicine¹⁰, Manuel Battegay, professor of infectious diseases², Heiner C Bucher, professor of clinical epidemiology¹, Swiss HIV Cohort Study Group

¹ Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, Basle, CH-4031, Switzerland, ² Division of infectious Diseases and Hospital Hygiene, University Hospital Basel, ³ Institute of Nursing Science, University of Basel, Basle, ⁴ Division of Infectious Diseases, University of Zurich, Zurich, Switzerland, ⁵ Data Centre of the Swiss HIV Cohort Study, University of Lausanne, Lausanne, Switzerland, ⁶ Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland, ⁷ Ambulattorio malattie infettive, Ospedale Civico, Lugano, Switzerland, ⁸ Division des maladies infectieuses, Hôpital Universitaire de Genève, Geneva, Switzerland, ⁹ Division des maladies infectieuses, Centre Hospitalier Universitaire Vaudois, Lausanne, ¹⁰ Division of Internal Medicine, Cantonal Hospital Saint Gall, Saint Gall, Switzerland

Correspondence to: H C Bucher hbucher{at}uhbs.ch

Objectives To explore the association between a stable partnershipand clinical outcome in HIV infected patients receiving highlyactive antiretroviral therapy (HAART).

Design Prospective cohort study of adults with HIV (Swiss HIVcohort study).

Setting Seven outpatient clinics throughout Switzerland.

Participants The 3736 patients in the cohort who started HAARTbefore 2002 (median age 36 years, 29% female, median followup 3.6 years).

Main outcome measures Time to AIDS or death (primary endpoint),death alone, increases in CD4 cell count of at least 50 and100 above baseline, optimal viral suppression (a viral loadbelow 400 copies/ml), and viral rebound.

Results During follow up 2985 (80%) participants reported astable partnership on at least one occasion. When starting HAART,52% (545/1042) of participants reported a stable partnership;after five years of follow up 46% (190/412) of participantsreported a stable partnership. In an analysis stratified byprevious antiretroviral therapy and clinical stage when startingHAART (US Centers for Disease Control and Prevention group A,B, or C), the adjusted hazard ratio for progression to AIDSor death was 0.79 (95% confidence interval 0.63 to 0.98) forparticipants with a stable partnership compared with those without.Adjusted hazards ratios for other endpoints were 0.59 (0.44to 0.79) for progression to death, 1.15 (1.06 to 1.24) for anincrease in CD4 cells of 100 counts/µl or more, and 1.06(0.98 to 1.14) for optimal viral suppression.

Conclusions A stable partnership is associated with a slowerrate of progression to AIDS or death in HIV infected patientsreceiving HAART.

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