Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort

Alan R. Lifson, Elizabeth M. Krantz, Patricia L. Grambsch, Grace E. Macalino, Nancy F. Crum-Cianflone, Anuradha Ganesan, Jason F. Okulicz, Anne Eaton, John H. Powers, Lynn E. Eberly, Brian K. Agan, Susan Banks, Mary Bavaro, Helen Chun, Cathy Decker, Connor Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur JohnsonMark Kortepeter, Tahaniyat Lalani, Michael Landrum, Michelle Linfesty, Scott Merritt, Robert O'Connell, Sheila Peel, Michael Polis, Roseanne Ressnerk, Edmund Tramont, Tyler Warkentien, Paige Waterman, Amy Weintrob, Timothy Whitman, Glenn Wortmann, Michael Zapor

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number4
JournalAIDS Research and Therapy
Volume9
DOIs
StatePublished - Feb 10 2012

Keywords

  • CD4+ lymphocyte count
  • Highly active antiretroviral therapy
  • Mortality

ASJC Scopus subject areas

  • Molecular Medicine
  • Virology
  • Pharmacology (medical)

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    Lifson, A. R., Krantz, E. M., Grambsch, P. L., Macalino, G. E., Crum-Cianflone, N. F., Ganesan, A., Okulicz, J. F., Eaton, A., Powers, J. H., Eberly, L. E., Agan, B. K., Banks, S., Bavaro, M., Chun, H., Decker, C., Eggleston, C., Fraser, S., Hartzell, J., Hsue, G., ... Zapor, M. (2012). Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort. AIDS Research and Therapy, 9, [4]. https://doi.org/10.1186/1742-6405-9-4