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Clinical, Demographic and Laboratory Parameters at HAART Initiation Associated with Decreased Post-HAART Survival in a U.S. Military Prospective HIV Cohort
MINNESOTA UNIV MINNEAPOLIS
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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 deaths100 person-years PY in those with 880450 CD4 cellsmm3 before HAART initiation, and became progressively lower as CD4 counts increased 0.70100 PY with 8805500 CD4 cellsmm3. In multivariate analysis, factors significantly p0.05 associated with post-HAART mortality included increasing age among those 880540 years Hazard ratio HR 1.32 per 5 year increase, clinical AIDS events before HAART HR1.93, 880450 CD4 cellsmm3 vs. CD4 8805500, HR2.97, greater HIV RNA level HR1.36 per one log10 increase, hepatitis C antibody or chronic hepatitis B HR1.96, and HIV diagnosis before 1996 HR2.44. Baseline CD4 51-200 cells HR1.74, p0.06, and hemoglobin 12 gmdL for women or 13.5 for men HR1.36, p0.07 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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