Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort studyBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7430.15 (Published 01 January 2004) Cite this as: BMJ 2004;328:15
- Jim Young, biostatistician1,
- Geest Sabina De, 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 () Swiss HIV Cohort Study Group, professor of clinical epidemiology1
- 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
- Accepted 10 October 2003
Objectives To explore the association between a stable partnership and clinical outcome in HIV infected patients receiving highly active antiretroviral therapy (HAART).
Design Prospective cohort study of adults with HIV (Swiss HIV cohort study).
Setting Seven outpatient clinics throughout Switzerland.
Participants The 3736 patients in the cohort who started HAART before 2002 (median age 36 years, 29% female, median follow up 3.6 years).
Main outcome measures Time to AIDS or death (primary endpoint), death alone, increases in CD4 cell count of at least 50 and 100 above baseline, optimal viral suppression (a viral load below 400 copies/ml), and viral rebound.
Results During follow up 2985 (80%) participants reported a stable 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 participants reported a stable partnership. In an analysis stratified by previous antiretroviral therapy and clinical stage when starting HAART (US Centers for Disease Control and Prevention group A, B, or C), the adjusted hazard ratio for progression to AIDS or death was 0.79 (95% confidence interval 0.63 to 0.98) for participants with a stable partnership compared with those without. Adjusted hazards ratios for other endpoints were 0.59 (0.44 to 0.79) for progression to death, 1.15 (1.06 to 1.24) for an increase 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 slower rate of progression to AIDS or death in HIV infected patients receiving HAART.
Contributors HCB, RS, SDG, and JY designed the study. JY did the statistical analysis. MR, PV, MF, HF, EB, MB, BH, AT, and RW were responsible for patient recruitment, clinical assessment, and development of the questionnaire. MR was responsible for data quality. HCB, SDG, RS, and JY wrote the final report, assisted by all coauthors. HCB is the guarantor.
Funding This study was financed in the framework of the Swiss HIV cohort study, supported by the Swiss National Science Foundation (Grant no 3345-062041). The Basel Institute for Clinical Epidemiology is supported by a grant from santésuisse and the Gottfried and Julia Bangerter-Rhyner-Foundation. HCB and JY received research grants from santésuisse and the Gottfried and Julia Bangerter-Rhyner-Foundation.
Competing interests None declared.
Ethical approval The Swiss HIV cohort study was approved by the local ethical committees of the participating centres.
- Accepted 10 October 2003