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Mortality and loss to follow-up among HIV-infected persons on long-term antiretroviral therapy in Latin America and the Caribbean.

Carriquiry G, Fink V, Koethe JR, Giganti MJ, Jayathilake K, Blevins M, Cahn P, Grinsztejn B, Wolff M, Pape JW, Padgett D, Madero JS, Gotuzzo E, McGowan CC, Shepherd BE - J Int AIDS Soc (2015)

Bottom Line: Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions.Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47-1.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.63-2.32) for 50 vs. 350 cells/µL; p<0.001) and older age (HR=1.47 (95% CI 1.29-1.69) for 50 vs. 30 years at ART initiation; p<0.001).In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru; gabriela.carriquiry.c@upch.pe; gabriela.carriquiry@yahoo.com.

ABSTRACT

Introduction: Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow-up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet).

Methods: We assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART-naïve adults (≥18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan-Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre-ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen.

Results: A total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.6-6.2). The median age at ART initiation was 36 years (IQR: 30-44), subjects were predominantly male (63%), median CD4 count was 156 cells/µL (IQR: 60-251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non-nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.5-18.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five-year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47-1.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.63-2.32) for 50 vs. 350 cells/µL; p<0.001) and older age (HR=1.47 (95% CI 1.29-1.69) for 50 vs. 30 years at ART initiation; p<0.001).

Conclusions: In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa.

No MeSH data available.


Related in: MedlinePlus

CD4 at ART initiation. The radius of each circle is proportional to the number of patients starting ART for a given site and year.
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Figure 0001: CD4 at ART initiation. The radius of each circle is proportional to the number of patients starting ART for a given site and year.

Mentions: A total of 16,996 antiretroviral-naïve subjects initiating ART were included in this study: 2408 (14%) from HF/CMH-Argentina, 2273 (13%) from FIOCRUZ-Brazil, 1697 (10%) from FA-Chile, 6468 (38%) from GHESKIO-Haiti, 960 (6%) from IHSS/HE-Honduras, 1010 (6%) from INNSZ-Mexico and 2180 (13%) from IMTAvH-Peru. Patient characteristics at ART initiation by site are given in Table 1. ART initiators were predominantly male (63%) ranging from 44% in GHESKIO-Haiti to 89% in FA-Chile. The median age at ART initiation was 36 years (interquartile range (IQR): 30–44 years). Twenty-six percent of subjects had clinical AIDS prior to starting ART. The median pre-ART CD4 count was 156 cells/µl (IQR: 60–251 cells/µl), but this increased with calendar year; trends in CD4 at ART initiation for each site are shown in Figure 1. The median year of ART initiation was 2008, and the vast majority of subjects (86%) started a regimen containing a non-nucleoside reverse transcriptase inhibitor (NNRTI).


Mortality and loss to follow-up among HIV-infected persons on long-term antiretroviral therapy in Latin America and the Caribbean.

Carriquiry G, Fink V, Koethe JR, Giganti MJ, Jayathilake K, Blevins M, Cahn P, Grinsztejn B, Wolff M, Pape JW, Padgett D, Madero JS, Gotuzzo E, McGowan CC, Shepherd BE - J Int AIDS Soc (2015)

CD4 at ART initiation. The radius of each circle is proportional to the number of patients starting ART for a given site and year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499577&req=5

Figure 0001: CD4 at ART initiation. The radius of each circle is proportional to the number of patients starting ART for a given site and year.
Mentions: A total of 16,996 antiretroviral-naïve subjects initiating ART were included in this study: 2408 (14%) from HF/CMH-Argentina, 2273 (13%) from FIOCRUZ-Brazil, 1697 (10%) from FA-Chile, 6468 (38%) from GHESKIO-Haiti, 960 (6%) from IHSS/HE-Honduras, 1010 (6%) from INNSZ-Mexico and 2180 (13%) from IMTAvH-Peru. Patient characteristics at ART initiation by site are given in Table 1. ART initiators were predominantly male (63%) ranging from 44% in GHESKIO-Haiti to 89% in FA-Chile. The median age at ART initiation was 36 years (interquartile range (IQR): 30–44 years). Twenty-six percent of subjects had clinical AIDS prior to starting ART. The median pre-ART CD4 count was 156 cells/µl (IQR: 60–251 cells/µl), but this increased with calendar year; trends in CD4 at ART initiation for each site are shown in Figure 1. The median year of ART initiation was 2008, and the vast majority of subjects (86%) started a regimen containing a non-nucleoside reverse transcriptase inhibitor (NNRTI).

Bottom Line: Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions.Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47-1.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.63-2.32) for 50 vs. 350 cells/µL; p<0.001) and older age (HR=1.47 (95% CI 1.29-1.69) for 50 vs. 30 years at ART initiation; p<0.001).In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru; gabriela.carriquiry.c@upch.pe; gabriela.carriquiry@yahoo.com.

ABSTRACT

Introduction: Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow-up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet).

Methods: We assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART-naïve adults (≥18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan-Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre-ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen.

Results: A total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.6-6.2). The median age at ART initiation was 36 years (IQR: 30-44), subjects were predominantly male (63%), median CD4 count was 156 cells/µL (IQR: 60-251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non-nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.5-18.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five-year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47-1.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.63-2.32) for 50 vs. 350 cells/µL; p<0.001) and older age (HR=1.47 (95% CI 1.29-1.69) for 50 vs. 30 years at ART initiation; p<0.001).

Conclusions: In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa.

No MeSH data available.


Related in: MedlinePlus