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Survival After AIDS Diagnosis in Italy, 1999-2006: A Population-Based Study

Serraino, Diego MD*; Zucchetto, Antonella ScD*; Suligoi, Barbara MD†; Bruzzone, Silvia ScD‡; Camoni, Laura ScD†; Boros, Stefano ScD†; Paoli, Angela De ScD*; Maso, Luigino Dal ScD*; Franceschi, Silvia MD§; Rezza, Giovanni MD†

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 2009 - Volume 52 - Issue 1 - pp 99-105
doi: 10.1097/QAI.0b013e3181a4f663
Epidemiology and Social Science

Objectives: To provide survival estimates of Italian people with AIDS (PWA) in the highly active antiretroviral therapy era and to identify prognostic factors at diagnosis and illnesses present at death.

Design: Longitudinal study with all-cause mortality as end point.

Methods: The vital status and illnesses present at death of the 9662 Italian PWA diagnosed from 1999 to 2005 were evaluated through a record linkage with the Italian mortality database. The survival was estimated through Kaplan-Meier method, whereas hazard ratios were computed to identify prognostic factors in the first 12 months or later.

Results: 80.6% of PWA survived 1 year, 75.2% 2 years, and 66.4% 5 years. Elevated death risks emerged among older individuals, injection drug users, and those with a CD4+ cell count <200. Non-Hodgkin lymphoma at AIDS diagnosis was the strongest negative prognostic factor, particularly in the first 12 months after AIDS (hazard ratio = 9.2, for primary brain lymphoma). At death, non-AIDS-defining illnesses increased from 38.4% in 1999 to 56.9% in 2006, with non-AIDS-defining cancers rising from 3.7% to 8.7%.

Conclusions: Our study documented the prolonged survival of Italian PWA, the strong impact of non-Hodgkin lymphoma on mortality, and the increasing frequency of non-AIDS-defining illnesses at death.

From the *Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy; †Dipartimento di Malattie Infettive, Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy; ‡Direzione centrale per le statistiche e le indagini sulle istituzioni sociali, Servizio Sanità e Assistenza ISTAT, Roma, Italy; and §International Agency for Research on Cancer, Lyon, France.

Received for publication November 24, 2008; accepted March 6, 2009.

The study received financial support from the Progetto Nazionale AIDS 2006, Istituto Superiore di Sanità (a nonprofit institution), grant numbers: ISS 20G.3 and ISS 20G.12.

The authors have no conflicts of interest to declare.

Correspondence to: Diego Serraino, MD, Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Via F. Gallini 2, 33081 Aviano, Pordenone, Italy (e-mail: serrainod@cro.it).

© 2009 Lippincott Williams & Wilkins, Inc.