Impact of opportunistic disease on survival in patients with HIV infection

Richard E. Chaisson, Joel E. Gallant, Jeanne C. Keruly, Richard D. Moore

Research output: Contribution to journalArticlepeer-review

124 Scopus citations


Objective: To assess the impact of opportunistic diseases on survival in patients with HIV disease. Methods: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. Results: During follow-up, 730 (35%) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independently of CD4 cell count (all P < 0.001 for opportunistic diseases controlling for CD4 cell count). The magnitude of increased risk was greatest for lymphoma [relative hazard (RH), 7.2], PML (RH, 3.9), MAC (RH, 3.0) and CMV (RH, 2.2). Cryptococcosis (RH, 0.94) and herpes zoster (RH, 0.85) were not associated with death. In a multivariate Cox proportional hazards analysis, MAC [RH, 2.56; 95% confidence interval (CI), 2.1-3.1], CMV (RH, 1.63; 95% CI, 1.3-2.1), toxoplasmosis (RH, 1.85; 95% CI, 1.3-2.6), PCP (RH, 1.29; 95% CI, 1.1-1.5), and CD4 cell count were significantly greatly monthly declines in CD4 counts (-11 x 106/l per month) than those who did not (-6 x 106/l per month; P < 0.001). Conclusion: Most opportunistic diseases increase the risk of death independently of CD4 cell count. These data support the hypothesis that opportunistic diseases enhance HIV pathogenesis and further underscore the importance of prophylaxis.

Original languageEnglish (US)
Pages (from-to)29-33
Number of pages5
Issue number1
StatePublished - Jan 1 1998


  • CD4 lymphocytes
  • HIV
  • Natural history
  • Opportunistic infections
  • Survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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