Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients\r\nreceiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of\r\npost-HAART mortality.\r\nMethods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including\r\nCD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in\r\na prospective observational cohort of HIV-infected U.S. military personnel.\r\nResults: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23\r\ndeaths/100 person-years [PY]) in those with = 50 CD4+ cells/mm3 before HAART initiation, and became progressively\r\nlower as CD4+ counts increased (0.70/100 PY with = 500 CD4+ cells/mm3). In multivariate analysis, factors significantly\r\n(p < 0.05) associated with post-HAART mortality included: increasing age among those = 40 years (Hazard ratio [HR] =\r\n1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), = 50 CD4+ cells/mm3 (vs. CD4+ = 500, HR =\r\n2.97), greater HIV RNA level (HR = 1.36 per one log10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96),\r\nand HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12\r\ngm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.\r\nConclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART\r\ninitiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset\r\nof patients for whom more intensive monitoring, counseling, and care interventions may improve clinical\r\noutcomes and post-HAART survival.
Loading....