Document Detail


Predictors of 5-years mortality in HIV-infected adults starting highly active antiretroviral therapy (HAART) in Thailand.
MedLine Citation:
PMID:  22293548     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To estimate early and long-term mortality and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand. DESIGN: Prospective observational cohort. METHODS: Previously untreated adults starting HAART in 2002-2009 were followed in 43 public hospitals. Kaplan-Meier probability of survival was estimated up to 5 years of therapy. Factors associated with early (≤6 months) and long-term (>6 months) mortality were assessed using Cox regression analyses. RESULTS: A total of 1578 adults received HAART, 74% women, median age 33 years, CD4 count 124 cells/mL, median follow-up was 50 months (IQR 41-66). Eighty-nine (6%) patients died (37 occurred ≤6 months and 52 >6 months) and 183 (12%) were lost to follow-up. Probability of survival (95%CI) was 97.5% (96.7-98.2) at 6 months; 96.6% (95.6-97.4) at 1 year and 93.5% (91.9-94.8%) at 5 years. Probability of being alive and on follow-up was 80.8% (78.5-82.8) at 5 years.Early mortality was associated with anemia (aHR 3.6, 95%CI 1.7-7.5) and low CD4 (aHR 1.6, 95%CI 1.1-2.2, per 50 cells decrease) at treatment initiation. Long-term mortality was associated with persistent anemia (aHR, 4.9; 95%CI 2.1-11.6); CD4 increase from baseline <50cells/mm (aHR 3.1; 95%CI 1.6-5.7) and viral load >1000 copies/mL (aHR 2.8; 95%CI 1.3-6.1) at 6 months of HAART; male gender and calendar year of enrollment. CONCLUSION: Early mortality was associated with anemia and severe immunosuppression at initiation of therapy. Long-term mortality was associated with persistent anemia, CD4 and virologic response at 6 months of therapy over baseline characteristics, highlighting the importance of laboratory monitoring.
Authors:
Federica Fregonese; Intira J Collins; Gonzague Jourdain; Sophie Lecoeur; Tim R Cressey; Nicole Ngo-Giang-Houng; Sukit Banchongkit; Apichat Chutanunta; Malee Techapornroong; Marc Lallemant;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-30
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  -     ISSN:  1944-7884     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Program for HIV Prevention and Treatment (IRD UMI 174), Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut de Recherché pour le Développement (IRD), Marseille, France; Harvard School of Public Health, Boston, MA, USA 2Padova University, Padua, Italy 3Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK 4Unité Mixte de Recherche 196 Centre Français de la Population et du Développement F-75006,(INED, IRD, Paris V University), Paris, France 5Rayong Hospita,l Rayong, Thailand 6Samutsakhon Hospital, Samutsakhon, Thailand 7Prapokklao Hospital, Chantaburi, Thailand Contact information: Federica Fregonese, c/o Program for HIV Prevention and Treatment (PHPT), 187/10 Changklan Rd., Changklan, Muang, Chiang Mai 50100, Thailand, Tel: +66 (0) 5381 9125 to 29 Fax: + 66 (0) 5381 9130, e-mail: Federica.Fregonese@phpt.org. Alternative e-mail: fregonese@post.harvard.edu.
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