Clinical, Demographic and Laboratory Parameters at HAART Initiation Associated with Decreased Post-HAART Survival in a U.S. Military Prospective HIV Cohort

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 HIVinfected 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 &#8804;50 CD4+ cells/mm3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with &#8805;500 CD4+ cells/mm3). In multivariate analysis, factors significantly (p<0.05) associated with post-HAART mortality included: increasing age among those &#8805;40 years (Hazard ratio [HR]= 1.32 per 5 year increase), clinical AIDS events before HAART (HR=1.93), &#8804;50 CD4+ cells/mm3 (vs. CD4+ &#8805;500, HR=2.97), greater HIV RNA level (HR=1.36 per one log10 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.

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Document Details

Document Type
Technical Report
Publication Date
Feb 10, 2012
Accession Number
ADA556393

Entities

People

  • Alan R. Lifson
  • Anne Eaton
  • Anuradha Ganesan
  • Elizabeth M. Krantz
  • Grace E. Macalino
  • Jason F. Okulicz
  • John H. Powers
  • Lynn E. Eberly
  • Nancy F Crum-Cianflone
  • Patricia L. Grambsch

Organizations

  • University of Minnesota

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Antibodies
  • Counseling
  • Data Science
  • Department Of Defense
  • Diseases And Disorders
  • Hemoglobin
  • Hepatitis
  • Infectious Diseases
  • Information Science
  • Intervention
  • Medical Personnel
  • Military Personnel
  • Monitoring
  • Multivariate Analysis
  • Natural History
  • Survival

Fields of Study

  • Medicine

Readers

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