Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand
Objective: To estimate the early and long-term mortalities and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand. Design: A prospective observational cohort study. Methods: Previously untreated adults starting HAART in 2002-2009 were followed-up in...
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th-cmuir.6653943832-8942014-08-29T09:02:18Z Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand Fregonese F. Collins I.J. Jourdain G. LeCoeur S. Cressey T.R. Ngo-Giang-Houng N. Banchongkit S. Chutanunta A. Techapornroong M. Lallemant M. Objective: To estimate the early and long-term mortalities and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand. Design: A prospective observational cohort study. Methods: Previously untreated adults starting HAART in 2002-2009 were followed-up 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) mortalities were assessed using Cox regression analyses. Results: A total of 1578 adults received HAART (74% women; median age, 33 years; CD4 cell count, 124/mL), with a median followup of 50 months (interquartile range, 41-66). Eighty-nine patients (6%) died (37 occurred ≤6 months and 52 occurred >6 months) and 183 (12%) were lost to follow-up. Probability of survival [95% confidence interval (CI)] was 97.5% (96.7% to 98.2%) at 6 months, 96.6% (95.6% to 97.4%) at 1 year, and 93.5% (91.9% to 94.8%) at 5 years. Probability of being alive and on follow-up was 80.8% (78.5% to 82.8%) at 5 years. Early mortality was associated with anemia [adjusted hazard ratio (aHR) 3.6, 95% CI: 1.7 to 7.5] and low CD4 count (aHR 1.6, 95% CI: 1.1 to 2.2 per 50 cells decrease) at treatment initiation. Long-term mortality was associated with persistent anemia (aHR 4.9, 95% CI: 2.1 to 11.6), CD4 increase from baseline ,50 cells per cubic millimeter (aHR 3.1, 95% CI: 1.6 to 5.7), and viral load >1000 copies per milliliter (aHR 2.8, 95% CI: 1.3 to 6.1) at 6 months of HAART; male gender; and calendar year of enrollment. Conclusions: Early mortality was associated with anemia and severe immunosuppression at initiation of therapy. Long-term mortality was associated with persistent anemia, CD4 count increase, and virological response at 6 months of therapy over baseline characteristics, highlighting the importance of laboratory monitoring. Copyright © 2012 by Lippincott Williams & Wilkins. 2014-08-29T09:02:18Z 2014-08-29T09:02:18Z 2012 Article 15254135 10.1097/QAI.0b013e31824bd33f 22293548 JJASF http://www.scopus.com/inward/record.url?eid=2-s2.0-84862126574&partnerID=40&md5=c44f5b69cb75d1e75b9fb95e673bbba4 http://cmuir.cmu.ac.th/handle/6653943832/894 English |
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Objective: To estimate the early and long-term mortalities and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand. Design: A prospective observational cohort study. Methods: Previously untreated adults starting HAART in 2002-2009 were followed-up 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) mortalities were assessed using Cox regression analyses. Results: A total of 1578 adults received HAART (74% women; median age, 33 years; CD4 cell count, 124/mL), with a median followup of 50 months (interquartile range, 41-66). Eighty-nine patients (6%) died (37 occurred ≤6 months and 52 occurred >6 months) and 183 (12%) were lost to follow-up. Probability of survival [95% confidence interval (CI)] was 97.5% (96.7% to 98.2%) at 6 months, 96.6% (95.6% to 97.4%) at 1 year, and 93.5% (91.9% to 94.8%) at 5 years. Probability of being alive and on follow-up was 80.8% (78.5% to 82.8%) at 5 years. Early mortality was associated with anemia [adjusted hazard ratio (aHR) 3.6, 95% CI: 1.7 to 7.5] and low CD4 count (aHR 1.6, 95% CI: 1.1 to 2.2 per 50 cells decrease) at treatment initiation. Long-term mortality was associated with persistent anemia (aHR 4.9, 95% CI: 2.1 to 11.6), CD4 increase from baseline ,50 cells per cubic millimeter (aHR 3.1, 95% CI: 1.6 to 5.7), and viral load >1000 copies per milliliter (aHR 2.8, 95% CI: 1.3 to 6.1) at 6 months of HAART; male gender; and calendar year of enrollment. Conclusions: Early mortality was associated with anemia and severe immunosuppression at initiation of therapy. Long-term mortality was associated with persistent anemia, CD4 count increase, and virological response at 6 months of therapy over baseline characteristics, highlighting the importance of laboratory monitoring. Copyright © 2012 by Lippincott Williams & Wilkins. |
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Article |
author |
Fregonese F. Collins I.J. Jourdain G. LeCoeur S. Cressey T.R. Ngo-Giang-Houng N. Banchongkit S. Chutanunta A. Techapornroong M. Lallemant M. |
spellingShingle |
Fregonese F. Collins I.J. Jourdain G. LeCoeur S. Cressey T.R. Ngo-Giang-Houng N. Banchongkit S. Chutanunta A. Techapornroong M. Lallemant M. Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
author_facet |
Fregonese F. Collins I.J. Jourdain G. LeCoeur S. Cressey T.R. Ngo-Giang-Houng N. Banchongkit S. Chutanunta A. Techapornroong M. Lallemant M. |
author_sort |
Fregonese F. |
title |
Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
title_short |
Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
title_full |
Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
title_fullStr |
Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
title_full_unstemmed |
Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand |
title_sort |
predictors of 5-year mortality in hiv-infected adults starting highly active antiretroviral therapy in thailand |
publishDate |
2014 |
url |
http://www.scopus.com/inward/record.url?eid=2-s2.0-84862126574&partnerID=40&md5=c44f5b69cb75d1e75b9fb95e673bbba4 http://cmuir.cmu.ac.th/handle/6653943832/894 |
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1681419568962076672 |