International Journal of Epidemiology, Vol 26, 400-407, Copyright © 1997 by International Epidemiological Association
AJ Mocroft, JD Lundgren, A d'Armino Monforte, B Ledergerber, SE Barton, S Vella, C Katlama, J Gerstoft, C Pedersen and AN Phillips
BACKGROUND: There are known to be wide differences in the prognosis of
patients with a diagnosis of AIDS. In this study of 6578 patients with AIDS
form 17 European centres, we develop a ranking of AIDS-defining illnesses,
and determine how well this ranking holds after adjustment for potential
confounding variables. METHODS: Survival from each AIDS- defining event was
calculated and ranked using Kaplan-Meier estimation of median survival. Cox
proportional hazards models with each disease modelled as a time dependant
covariate were used to determine the risk of death after each diagnosis,
before and after adjustment for potential confounders. RESULTS: Median
survival after an initial AIDS- defining diagnosis of progressive
multifocal leukoencephalopathy and malignant lymphoma was particularly poor
(2 and 5 months respectively), while the longest median survival occurred
after initial AIDS-defining illnesses of Kaposi's sarcoma and
extrapulmonary tuberculosis (17 and 22 months respectively) Patients
diagnosed with a primary brain lymphoma had shorter median survival times
than patients with a peripheral lymphoma (median survival of 1 month and 4
months respectively P < 0.0001). In general, median survival in patients
with cutaneous Kaposi's sarcoma (skin, oral) was between two and four times
longer than patients with systemic involvement The ranking of diseases was
found to be generally similar after adjustment for all potential
confounders. CONCLUSIONS: AIDS-defining events can be grouped into three
categories with median survival after diagnosis of < 6 months. 6- 12
months and > 12 months. The assigned ranking of disease would not be
altered by prognostic factors such as age or CD4 lymphocyte count. These
results have important implications in the design of clinical trials and
patient management.
ARTICLES
Survival of AIDS patients according to type of AIDS-defining event. The AIDS in Europe Study Group
Dept Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
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