Document Detail


Long-term antiretroviral treatment outcomes in seven countries in the Caribbean.
MedLine Citation:
PMID:  22240464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To report long-term HIV treatment outcomes in 7 Caribbean countries.
DESIGN: Observational cohort study.
METHODS: We report outcomes for all antiretroviral therapy (ART) naive adult patients enrolled on ART from program inception until study closing for cohorts in Barbados, the Dominican Republic, Haiti, Jamaica, Martinique, Trinidad, and Puerto Rico. Incidence and predictors of mortality were analyzed by time-to-event approaches.
RESULTS: A total of 8203 patients were on ART from 1998 to 2008. Median follow-up time was 31 months (interquartile range: 14-50 months). The overall mortality was 13%: 6% in Martinique, 8% in Jamaica, 11% in Trinidad, 13% in Haiti, 15% in the Dominican Republic, 15% in Barbados, and 24% in Puerto Rico. Mortality was associated with male gender [hazard ratio (HR), 1.58; 95% confidence interval (CI): 1.33 to 1.87], body weight (HR, 0.85 per 10 pounds; 95% CI: 0.82 to 0.89), hemoglobin (HR, 0.84 per g/dL; 95% CI: 0.80 to 0.88), CD4 cell count (0.90 per 50 CD4 cells; 95% CI: 0.86 to 0.93), concurrent tuberculosis (HR, 1.58; 95% CI: 1.25 to 2.01) and age (HR, 1.19 per 10 years; 95% CI: 1.11 to 1.28). After controlling for these variables, mortality in Martinique, Jamaica, Trinidad, and Haiti was not significantly different. A total of 75% of patients remained alive and in care at the end of the study period.
CONCLUSIONS: Long-term mortality rates vary widely across the Caribbean countries. Much of the difference can be explained by disease severity at ART initiation, nutritional status, and concurrent tuberculosis. Earlier ART initiation will be critical to improve the outcomes.
Authors:
Serena P Koenig; Luis A Rodriguez; Courtenay Bartholomew; Alison Edwards; Tracie E Carmichael; Geoffrey Barrow; André Cabié; Robert Hunter; Giselle Vasquez-Mora; Avion Quava-Jones; Nicholas Adomakoh; J Peter Figueroa; Bernard Liautaud; Magaly Torres; Jean W Pape
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  59     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-12     Completed Date:  2012-05-02     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e60-71     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Retroviral Agents / therapeutic use*
Body Weight
CD4 Lymphocyte Count
Caribbean Region
Cohort Studies
Comorbidity
Female
HIV Infections / drug therapy*,  mortality
Hemoglobins / analysis
Humans
Incidence
Male
Severity of Illness Index
Sex Factors
Treatment Outcome
Tuberculosis, Pulmonary / epidemiology
Grant Support
ID/Acronym/Agency:
3 U2R TW006896-04S1/TW/FIC NIH HHS; G12RR-03035/RR/NCRR NIH HHS; K01 TW007142/TW/FIC NIH HHS; K01 TW007142/TW/FIC NIH HHS; K01 TW007142-07/TW/FIC NIH HHS; P30 AI060354/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/Hemoglobins
Comments/Corrections

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