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AIDS Res Ther. 2012; 9: 4.
Published online Feb 10, 2012. doi:  10.1186/1742-6405-9-4
PMCID: PMC3320559
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,corresponding author1,3 Elizabeth M Krantz,2,3 Patricia L Grambsch,2,3 Grace E Macalino,3 Nancy F Crum-Cianflone,3,4 Anuradha Ganesan,3,5 Jason F Okulicz,3,6 Anne Eaton,2 John H Powers,7 Lynn E Eberly,2,3 and Brian K Agancorresponding author3, the Infectious Disease Clinical Research Program HIV/STI Working Group bagan@idcrp.org
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
corresponding authorCorresponding author.
Alan R Lifson: lifso001/at/umn.edu; Elizabeth M Krantz: ekrantz/at/ccbr.umn.edu; Patricia L Grambsch: gramb001/at/umn.edu; Grace E Macalino: gmacalino/at/idcrp.org; Nancy F Crum-Cianflone: nancy.crum/at/med.navy.mil; Anuradha Ganesan: anuradha.ganesan/at/med.navy.mil; Jason F Okulicz: jason.okulicz/at/amedd.army.mil; Anne Eaton: eatona/at/mskcc.org; John H Powers: powersjo/at/niaid.nih.gov; Lynn E Eberly: lynn/at/biostat.umn.edu; Brian K Agan: bagan/at/idcrp.org
Received September 19, 2011; Accepted February 10, 2012.
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 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/mm3 before 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 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.
Keywords: Highly active antiretroviral therapy, mortality, CD4+ lymphocyte count
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