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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

Probability of mortality from start of ART by site.The solid lines represent the Kaplan-Meier estimates, which assume the rate of death among those LTFU/censored is the same as it is among those remaining in follow-up. The dashed lines are the estimated average predicted probabilities based on patient characteristics at ART initiation, which account for differences between baseline characteristics of those LTFU/censored and those remaining in follow-up.
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Figure 0003: Probability of mortality from start of ART by site.The solid lines represent the Kaplan-Meier estimates, which assume the rate of death among those LTFU/censored is the same as it is among those remaining in follow-up. The dashed lines are the estimated average predicted probabilities based on patient characteristics at ART initiation, which account for differences between baseline characteristics of those LTFU/censored and those remaining in follow-up.

Mentions: The overall probability of death one, three and five years after initiating ART was 5.4% (95% CI 5.1–5.8), 8.3% (95% CI 7.9–8.8) and 10.3% (95% CI 9.8–10.8), respectively, although estimates were very heterogeneous across sites. For example, year five mortality probabilities were: 3.5, 10.5, 6.9, 14.0, 13.9, 5.5 and 10.1% for HF/CMH-Argentina, FIOCRUZ-Brazil, FA-Chile, GHESKIO-Haiti, IHSS/HE-Honduras, INNSZ-Mexico and IMTAvH-Peru, respectively. Figure 3 shows the estimated probability of mortality over time after ART initiation. The overall incidence of mortality was 22.2 per 1000 person-years (py), although it was high during the first year (57.8 deaths per 1000 py, ranging from 16.4 deaths per 1000 py in HF/CMH-Argentina to 87.4 per 1000 py in IHSS/HE-Honduras) and dropped to 12.6 deaths per 1000 py after the first year (ranging from 5.4 in HF/CMH-Argentina to approximately 16–17 per 1000 py in FIOCRUZ-Brazil, GHESKIO-Haiti and IHSS/HE-Honduras). Figure 3 also shows the average predicted probability of mortality per site, accounting for patient characteristics in those who were LTFU and censored; estimates were similar but slightly lower (The Supplementary file contains a data animation demonstrating survival and LTFU over by time by patient characteristics at ART initiation).


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)

Probability of mortality from start of ART by site.The solid lines represent the Kaplan-Meier estimates, which assume the rate of death among those LTFU/censored is the same as it is among those remaining in follow-up. The dashed lines are the estimated average predicted probabilities based on patient characteristics at ART initiation, which account for differences between baseline characteristics of those LTFU/censored and those remaining in follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Probability of mortality from start of ART by site.The solid lines represent the Kaplan-Meier estimates, which assume the rate of death among those LTFU/censored is the same as it is among those remaining in follow-up. The dashed lines are the estimated average predicted probabilities based on patient characteristics at ART initiation, which account for differences between baseline characteristics of those LTFU/censored and those remaining in follow-up.
Mentions: The overall probability of death one, three and five years after initiating ART was 5.4% (95% CI 5.1–5.8), 8.3% (95% CI 7.9–8.8) and 10.3% (95% CI 9.8–10.8), respectively, although estimates were very heterogeneous across sites. For example, year five mortality probabilities were: 3.5, 10.5, 6.9, 14.0, 13.9, 5.5 and 10.1% for HF/CMH-Argentina, FIOCRUZ-Brazil, FA-Chile, GHESKIO-Haiti, IHSS/HE-Honduras, INNSZ-Mexico and IMTAvH-Peru, respectively. Figure 3 shows the estimated probability of mortality over time after ART initiation. The overall incidence of mortality was 22.2 per 1000 person-years (py), although it was high during the first year (57.8 deaths per 1000 py, ranging from 16.4 deaths per 1000 py in HF/CMH-Argentina to 87.4 per 1000 py in IHSS/HE-Honduras) and dropped to 12.6 deaths per 1000 py after the first year (ranging from 5.4 in HF/CMH-Argentina to approximately 16–17 per 1000 py in FIOCRUZ-Brazil, GHESKIO-Haiti and IHSS/HE-Honduras). Figure 3 also shows the average predicted probability of mortality per site, accounting for patient characteristics in those who were LTFU and censored; estimates were similar but slightly lower (The Supplementary file contains a data animation demonstrating survival and LTFU over by time by patient characteristics at ART initiation).

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