Risk factors for early mortality on antiretroviral therapy in advanced HIV-infected adults.

TitleRisk factors for early mortality on antiretroviral therapy in advanced HIV-infected adults.
Publication TypeJournal Article
Year of Publication2017
AuthorsBisson GP, Ramchandani R, Miyahara S, Mngqibisa R, Matoga M, Ngongondo MN, Samaneka W, Koech L, Naidoo K, Rassool M, Kirui F, Banda P, Mave V, Kadam D, Leger P, Henestroza G, Manabe YC, Bao J, Kumwenda J, Gupta A, Hosseinipour MC
Corporate AuthorsAdult AIDS Clinical Trials Group A5274(REMEMBER) Study Team
JournalAIDS
Volume31
Issue16
Pagination2217-2225
Date Published2017 Oct 23
ISSN1473-5571
Abstract

BACKGROUND: Many HIV-infected individuals present with advanced HIV disease. These patients are at high risk of death after antiretroviral therapy (ART) initiation, but risk factors for death in these patients are unclear.

METHODS: We used data from a multisite randomized trial comparing empiric vs. preventive tuberculosis therapy in HIV-infected adults initiating ART with CD4 T-cell counts less than 50 cells/μl to evaluate risk factors for death within 48 weeks after ART initiation. Cox proportional hazards models were fit to evaluate characteristics present at baseline and at 4 weeks after ART initiation, including the week 4 CD4 T-cell response and new opportunistic infections.

RESULTS: Of 850 enrolled, the median pre-ART CD4 T-cell count was 18 cells/μl and 67 (7.9%) died. Baseline risk factors for death included lymphadenopathy, lower CD4 T-cell count, lower serum albumin, high white blood cell count, elevated neutrophil percentage, and lower hemoglobin. Among 746 participants with data at week 4, the median changes in CD4 T-cell count and viral load for those who died (n = 43) vs. survived were 26 vs. 56 cells/μl and -2.7 vs. -2.7 log10 copies/ml, respectively. Each 20 cell/μl lower change in week 4 CD4 T-cell count was associated with a 20% increased risk of post week-4 mortality (adjusted hazard ratio 1.20, 1.01-1.42, P = .038).

CONCLUSION: Evidence of active infection and suboptimal immunologic response during the first month of ART are associated with death in the first year after ART initiation in those with advanced HIV disease taking tuberculosis preventive therapy. Strategies to reduce early mortality in this population warrant further investigation.

DOI10.1097/QAD.0000000000001606
Alternate JournalAIDS
PubMed ID28742529
PubMed Central IDPMC5633516
Grant ListU01 AI069497 / AI / NIAID NIH HHS / United States
UM1 AI069423 / AI / NIAID NIH HHS / United States
UM1 AI069534 / AI / NIAID NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI069469 / AI / NIAID NIH HHS / United States
UM1 AI069518 / AI / NIAID NIH HHS / United States
R01 AI080417 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069463 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States
UM1 AI069465 / AI / NIAID NIH HHS / United States
U01 AI027659 / AI / NIAID NIH HHS / United States
U01 AI032783 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States