Clinical Spectrum and Treatment Outcome of HIV/ AIDS in Taiwan

We described the changes of clinical spectrum of AIDS-related opportunistic illnesses (AIDS-OIs) and assessed survival of 1044 HIV-infected persons enrolled in three periods: period 1, 1994 to 1997 (before introduction of highly active antiretroviral therapy [HAART]); period 2, 1997 to 2000 (early-HAART); and period 3, 2000 to 2004 (late-HAART). Nearly two-thirds of those persons who were newly diagnosed with HIV infection had CD4 count less than 200/mm3. Candidiasis, Pneumocystis carinii (P. jiroveci) pneumonia, and tuberculosis were the three most common diseases in all three study periods among a total of 1182 opportunistic illnesses within 3 months after enrollment. Within 3 to 12 months after enrollment, the number of opportunistic illnesses declined significantly and only 81 cases of opportunistic illnesses were diagnosed, and the most common illnesses included cytomegalovirus disease, tuberculosis, candidiasis, and Mycobacterium avium complex infection. As of 30 June 2005, 259 (24.8%) persons had died after a median observation duration of 985 days (range, 2-4025 days). The mortality rate declined from 33.75 per 100 person-years in pre-HAART era to 6.51 per 100 person-years in late-HAART era (P<0.0001). The adjusted hazard ratio for death in persons with a baseline CD4 count of <200 cells/μl in periods 2 and 3 was 0.605 (P=0.007) and 0.371 (P <0.0001), respectively, when compared with persons enrolled in period 1; the adjusted hazard ratio for death was 0.611 for persons enrolled in period 3 when compared to period 2 (P=0.01). Our study suggested that the incidence of AIDS-OI decreased significantly and survival of persons at late stage of HIV infection in Taiwan continued to improve in the late HAART era.