clinical, demographic and laboratory parameters at haart initiation associated with decreased post-haart survival in a u.s. military prospective hiv cohort

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AIDS Research and Therapy 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^1,3, Elizabeth M Krantz^2,3, Patricia L Grambsch^2,3, Grace E Macalino³, Nancy F Crum-Cianflone^3,4, Anuradha Ganesan^3,5, Jason F Okulicz^3,6, Anne Eaton², John H Powers⁷, Lynn E Eberly^2,3, Brian K Agan^3 and the Infectious Disease Clinical Research Program HIV/STI Working Group ¹Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA; ²Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA; ³Infectious Disease Clinical Research Program, Uniformed Services University of Health Sciences, Bethesda, MD, USA; ⁴Infectious Disease, Naval Medical Center San Diego, San Diego, CA, USA; ⁵Infectious Disease, National Naval Medical Center, Bethesda, MD, USA; ⁶Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, USA; ⁷National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA AIDS Research and Therapy 2012 Feb 10, 9:4 doi:10.1186/1742-6405-9-4
February 10, 2012

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/mm³before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm³). 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/mm³(vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log₁₀increase), 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. Keywords: Highly active antiretroviral therapy; mortality; CD4+ lymphocyte count ^*Corresponding authors: Alan R Lifson lifso001@umn.edu - Brian K Agan bagan@idcrp.org CLICK HERE FOR FULL-TEXT JOURNAL ARTICLE © 2012 Lifson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Copyright © 2012 - All articles published by AIDS Research and Therapy are made freely and permanently accessible online immediately upon publication, without subscription charges or registration barriers. Further information about open access can be found here. Authors of articles published in AIDS Research and Therapy are the copyright holders of their articles and have granted to any third party, in advance and in perpetuity, the right to use, reproduce or disseminate the article, according to the BioMed Central copyright and license agreement. Information in this article was accurate in February 10, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.

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