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Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7117.1194 (Published 08 November 1997) Cite this as: BMJ 1997;315:1194
  1. Matthias Egger (m.egger{at}bristol.ac.uk), senior lecturer in epidemiologya,
  2. Bernard Hirschel, professor of infectious diseasesb,
  3. Patrick Francioli, professor of epidemiology and hospital hygienec,
  4. Philippe Sudre, epidemiologistb,
  5. Marc Wirz, research fellowa,
  6. Markus Flepp, reader in internal medicined,
  7. Martin Rickenbach, epidemiologistc,
  8. Raffaele Malinverni, reader in internal medicinea,
  9. Pietro Vernazza, senior research fellowe,
  10. Manuel Battegay, reader in internal medicine and the Swiss HIV Cohort Studyf
  1. a Department of Social and Preventive Medicine and Outpatient Department of Internal Medicine, University of Berne, Berne, Switzerland
  2. b Division of Infectious Diseases, University of Geneva, Geneva
  3. c Division of Hospital Preventive Medicine and Infectious Diseases and Department of Social and Preventive Medicine, University of Lausanne, Lausanne
  4. d Division of Infectious Diseases, University of Zurich, Zurich
  5. e Division of Internal Medicine, Cantonal Hospital St Gall, St Gall
  6. f Outpatient Department of Internal Medicine, University of Basle, Basle
  1. The members of the Swiss HIV cohort study are listed at the end of the articleCorrespondence to: Dr M Egger Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR
  • Accepted 10 October 1997

Abstract

Objectives: To examine trends in disease progression and survival among patients enrolled in the Swiss HIV cohort study during 1988–96 and to assess the influence of new antiretroviral combination therapies.

Design: Prospective multicentre study, with follow up visits planned at six monthly intervals.

Setting: Seven HIV units at university centres and cantonal hospitals in Switzerland.

Patients: 3785 men (mean age 35.0 years) and 1391 women (30.3 years) infected with HIV. 2023 participants had a history of intravenous drug misuse; 1764 were men who had sex with men; 1261 were infected heterosexually; and 164 had other or unknown modes of transmission. 601 participants had had an AIDS defining illness.

Results: During more than 15 000 years of follow up, there were 1456 first AIDS defining diagnoses and 1903 deaths. Compared with those enrolled during 1988-90, the risk of progression to a first AIDS diagnosis was reduced by 18% (relative risk 0.82 (95% confidence interval 0.73 to 0.93)) among participants enrolled in 1991-2, by 23% (0.77 (0.65 to 0.91)) among those enrolled in 1993-4, and by 73% (0.27 (0.18 to 0.39)) among those enrolled in 1995-6. Mortality was reduced by 19% (0.81 (0.73 to 0.90)), 26% (0.74 (0.63 to 0.87)), and 62% (0.38 (0.25 to 0.97)) respectively. Compared with no antiretroviral treatment, the risk of an initial AIDS diagnosis after CD4 lymphocyte counts fell to <200 cellsx106/l was reduced by 16% (0.84 (0.73 to 0.97)) with monotherapy, 24% (0.76 (0.63 to 0.91)) with dual therapy, and 42% (0.58 (0.37 to 0.92)) with triple therapy. Mortality was reduced by 23% (0.77 (0.68 to 0.88)), 31% (0.69 (0.60 to 0.80)), and 65% (0.35 (0.20 to 0.60)) respectively.

Conclusions: The introduction of antiretroviral combination therapies outside the selected patient groups included in clinical trials has led to comparable reductions in disease progression and mortality.

Key messages

  • The Swiss HIV cohort study is an ongoing prospective study that includes a large proportion of the patients infected with HIV in Switzerland

  • Antiretroviral combination therapy with two nucleoside analogues was introduced in 1995, and triple therapy with protease inhibitors was introduced in 1996

  • The risk of AIDS and death was substantially lower among patients enrolling in 1995 and 1996 than among those enrolled in earlier years

  • Reductions in disease progression were similar among men and women and among patients from different transmission groups

  • In Switzerland the introduction of antiretroviral combination therapies outside selected patient groups included in clinical trials has led to similar reductions in disease progression

Footnotes

  • Accepted 10 October 1997
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