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

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.