TY - JOUR
T1 - Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort
AU - Lifson, Alan R.
AU - Krantz, Elizabeth M.
AU - Grambsch, Patricia L.
AU - Macalino, Grace E.
AU - Crum-Cianflone, Nancy F.
AU - Ganesan, Anuradha
AU - Okulicz, Jason F.
AU - Eaton, Anne
AU - Powers, John H.
AU - Eberly, Lynn E.
AU - Agan, Brian K.
AU - Banks, Susan
AU - Bavaro, Mary
AU - Chun, Helen
AU - Decker, Cathy
AU - Eggleston, Connor
AU - Fraser, Susan
AU - Hartzell, Joshua
AU - Hsue, Gunther
AU - Johnson, Arthur
AU - Kortepeter, Mark
AU - Lalani, Tahaniyat
AU - Landrum, Michael
AU - Linfesty, Michelle
AU - Merritt, Scott
AU - O'Connell, Robert
AU - Peel, Sheila
AU - Polis, Michael
AU - Ressnerk, Roseanne
AU - Tramont, Edmund
AU - Warkentien, Tyler
AU - Waterman, Paige
AU - Weintrob, Amy
AU - Whitman, Timothy
AU - Wortmann, Glenn
AU - Zapor, Michael
PY - 2012/2/10
Y1 - 2012/2/10
N2 - Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.
AB - Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.
KW - CD4+ lymphocyte count
KW - Highly active antiretroviral therapy
KW - Mortality
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U2 - 10.1186/1742-6405-9-4
DO - 10.1186/1742-6405-9-4
M3 - Article
C2 - 22339893
AN - SCOPUS:84856802811
VL - 9
JO - AIDS Research and Therapy
JF - AIDS Research and Therapy
SN - 1742-6405
M1 - 4
ER -