Rupasinghe, D. and Kiertiburanakul, S. and Kamarulzaman, Adeeba and Zhang, F. and Kumarasamy, N. and Chaiwarith, R. and Merati, T. P. and Do, C. D. and Khusuwan, S. and Avihingsanon, A. and Lee, M. P. and Ly, P. S. and Yunihastuti, E. and Nguyen, K. V. and Ditangco, R. and Chan, Y. J. and Pujari, S. and Ng, O. T. and Choi, J. Y. and Sim, B. L. H. and Tanuma, J. and Sangle, S. and Ross, J. and Law, M. (2020) Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific. HIV Medicine, 21 (6). pp. 397-402. ISSN 1464-2662, DOI https://doi.org/10.1111/hiv.12836.
Full text not available from this repository.Abstract
Objectives Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia-Pacific. Methods PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow-up as a competing risk. Results A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first-year mortality rate was 4.27 per 100 person-years (PY). Thirty-eight deaths (52%) were AIDS-related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)-related, 13 (18%) were non-AIDS-related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 sub-hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60-5.32] compared to BMI 18.5-24.9, and alanine aminotransferase (ALT) >= 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62-23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51-100 cells/mu L: SHR 0.28; 95% CI 0.14-0.55; and > 100 cells/mu L: SHR 0.12; 95% CI 0.05-0.26) was associated with reduced hazard for mortality compared to CD4 count <= 25 cells/mu L. Conclusions Fifty-two per cent of early deaths were AIDS-related. Efforts to initiate ART at CD4 counts > 50 cell/mu L are associated with improved short-term survival rates, even in those with late stages of HIV disease.
| Item Type: | Article |
|---|---|
| Funders: | TREAT Asia HIV Observational Database - International Epidemiology Databases to Evaluate AIDS (IeDEA) (U01AI069907), Australian Government Department of Health & Ageing |
| Uncontrolled Keywords: | Advanced disease; Asia-Pacific; HIV; mortality |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Medicine Department |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 10 Mar 2023 03:06 |
| Last Modified: | 10 Mar 2023 03:06 |
| URI: | http://eprints.um.edu.my/id/eprint/37214 |
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