%0 Journal Article
%T Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort
%A Alan R Lifson
%A Elizabeth M Krantz
%A Patricia L Grambsch
%A Grace E Macalino
%A Nancy F Crum-Cianflone
%A Anuradha Ganesan
%A Jason F Okulicz
%A Anne Eaton
%A John H Powers
%A Lynn E Eberly
%A Brian K Agan
%A the Infectious Disease Clinical Research Program HIV/STI Working Group
%J AIDS Research and Therapy
%D 2012
%I BioMed Central
%R 10.1186/1742-6405-9-4
%X 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 HIV-infected U.S. military personnel.Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ¡Ü 50 CD4+ cells/mm3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ¡Ý 500 CD4+ cells/mm3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ¡Ý 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ¡Ü 50 CD4+ cells/mm3 (vs. CD4+ ¡Ý 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.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.Although highly active antiretroviral therapy (HAART) has significantly reduced mortality in HIV-infected patients [1-3], some patients receiving therapy are still dying. Guidelines for patients on stable HAART recommend laboratory monitoring and follow-up every 3-6 months [4]. However, more frequent and intensive monitoring and care may be indicated for those at greatest risk of post-HAART adverse clinical outcomes. Although CD4+ count is an important determi
%K Highly active antiretroviral therapy
%K mortality
%K CD4+ lymphocyte count
%U http://www.aidsrestherapy.com/content/9/1/4