Using Multiple Drugs in Combination Helps Patients with Advanced AIDS

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled "Highly Active Antiretroviral Therapy Decreases Mortality and Morbidity in Patients with Advanced HIV Disease." It is in the 3 July 2001 issue of Annals of Internal Medicine (volume 135, pages 17-26). The authors are EL Murphy, AC Collier, LA Kalish, SF Assmann, MF Para, TP Flanigan, PN Kumar, L Mintz, FR Wallach, and GJ Nemo, for the Viral Activation Transfusion Study Investigators.

What is the problem and what is known about it so far?

Since 1996, combination therapies with antiretroviral drugs have been shown to increase length of life in many people with AIDS. (Drugs that suppress HIV, the virus that causes AIDS, are called antiretroviral drugs.) Combination therapy usually consists of taking three or four drugs of different types at the same time. Each of these drugs works in a different way against HIV. Combination therapy for AIDS is commonly called highly active antiretroviral therapy, or HAART. Currently, patients with newly diagnosed AIDS routinely receive HAART. Although we know that HAART can extend life for many of these patients, we do not know whether or how much HAART helps patients with severe or advanced, late-stage AIDS.

Why did the researchers do this particular study?

To find out whether HAART lengthens life and decreases medical complications in patients with advanced AIDS.

Who was studied?

The study included 528 patients with advanced AIDS. All patients had severe anemia (low red blood cell counts) that required blood cell transfusions. Most were men (79%). One third of the patients were not taking any antiretroviral therapy when they entered the study, one quarter were already taking HAART, and the remainder were taking some antiretroviral therapies that are less intensive than HAART.

How was the study done?

The researchers recruited and followed patients from 1995 to 1999. During routine quarterly visits, the researchers asked patients whether and when their doctors had started them on HAART. The researchers also reviewed medical records and pathology reports to find out whether any patients died or experienced infections or other medical complications related to AIDS.

What did the researchers find?

Doctors more often prescribed HAART in the later years of the study than in the earlier years. For example, only 1% of the study patients had been given HAART as of January 1996, whereas 79% had been given it as of January 1999. During follow-up, 289 (55%) of the 528 patients died. Patients who took HAART lived longer and had fewer AIDS-related medical complications than patients who did not take HAART.

What were the limitations of the study?

The researchers had limited ability to determine exactly whether the patients took HAART as prescribed. Also, many factors may contribute to better outcomes in patients with AIDS, and some of these factors may be related to whether patients took HAART. Although the investigators took into account many of these factors, sorting out whether the improved outcomes are due to HAART or other factors is very difficult.

What are the implications of the study?

Highly active antiretroviral therapy appears to lengthen life and decrease complications related to AIDS, even in patients with advanced AIDS.