Highly active antiretroviral therapy (HAART) has been shown to be effective in different populations, but data
among injection drug users are limited. Human immunodeficiency virus-infected injection drug users recruited into
the Acquired Immunodeficiency Syndrome Link to Intravenous Experiences (ALIVE) Study as early as 1988 were
tested semiannually to identify their first CD4-positive T-lymphocyte cell count below 200/ll; they were followed for
mortality through 2002. Visits were categorized into the pre-HAART (before mid-1996) and the HAART eras and
further categorized by HAART use. Survival analysis with staggered entry was used to evaluate the effect of
HAART on acquired immunodeficiency syndrome-related mortality, adjusting for other medications and demographic,
clinical, and behavioral factors. Among 665 participants, 258 died during 2,402 person-years of follow-up.
Compared with survival in the pre-HAART era, survival in the HAART era was shown by multivariate analysis to be
improved for both those who did and did not receive HAART (relative hazards ~ 0.06 and 0.33, respectively; p <
0.001). Inferences were unchanged after restricting analyses to data starting with 1993 and considerations of leadtime
bias and human immunodeficiency viral load. The annual CD4-positive T-lymphocyte cell decline was less in
untreated HAART-era participants than in pre-HAART-era participants (-10/microliter vs. -37/microliter, respectively), suggesting
that changing indications for treatment may have contributed to improved survival and that analyses restricted
to the HAART era probably underestimate HAART effectiveness.
Peer Reviewed
http://deepblue.lib.umich.edu/bitstream/2027.42/40266/2/Vlahov_Effectiveness of Highly Active Antiretroviral Therapy_2005.pdf