P2MTVCMX
type: UserItem
resource: Laboratory and clinical predictors of disease progression following initiation of combination therapy in HIV-infected adults in Thailand
repository: NCBI PubMed
tagged: AutoTag
  label: Adult
tagged: AutoTag
  label: Anti-HIV Agents
tagged: AutoTag
  label: CD4-Positive T-Lymphocytes
tagged: AutoTag
  label: Cohort Studies
tagged: AutoTag
  label: Disease Progression
tagged: AutoTag
  label: Female
tagged: AutoTag
  label: Follow-Up Studies
tagged: AutoTag
  label: HIV infections
tagged: AutoTag
  label: Humans
tagged: AutoTag
  label: Immunosuppression
tagged: AutoTag
  label: Male
tagged: AutoTag
  label: Multivariate Analysis
tagged: AutoTag
  label: Poisson Distribution
tagged: AutoTag
  label: Risk
tagged: AutoTag
  label: Thailand
tagged: AutoTag
  label: Viral Load

Laboratory and clinical predictors of disease progression following initiation of combination therapy in HIV-infected adults in Thailand
type: AcademicArticle
abstract: BACKGROUND Data on determinants of long-term disease progression in HIV-infected patients on antiretroviral therapy (ART) are limited in low and middle-income settings. METHODS Effects of current CD4 count, viral load and haemoglobin and diagnosis of AIDS-defining events (ADEs) after start of combination ART (cART) on death and new ADEs were assessed using Poisson regression, in patient aged ≥ 18 years within a multi-centre cohort in Thailand. RESULTS Among 1,572 patients, median follow-up from cART initiation was 4.4 (IQR 3.6-6.3) years. The analysis of death was based on 60 events during 6,573 person-years; 30/50 (60%) deaths with underlying cause ascertained were attributable to infections. Analysis of new ADE included 192 events during 5,865 person-years; TB and Pneumocystis jiroveci pneumonia were the most commonly presented first new ADE (35% and 20% of cases, respectively). In multivariable analyses, low current CD4 count after starting cART was the strongest predictor of death and of new ADE. Even at CD4 above 200 cells/mm(3), survival improved steadily with CD4, with mortality rare at ≥ 500 cells/mm(3) (rate 1.1 per 1,000 person-years). Haemoglobin had a strong independent effect, while viral load was weakly predictive with poorer prognosis only observed at ≥ 100,000 copies/ml. Mortality risk increased following diagnosis of ADEs during cART. The decline in mortality rate with duration on cART (from 21.3 per 1,000 person-years within first 6 months to 4.7 per 1,000 person-years at ≥ 36 months) was accounted for by current CD4 count. CONCLUSIONS Patients with low CD4 count or haemoglobin require more intensive diagnostic and treatment of underlying causes. Maintaining CD4 ≥ 500 cells/mm(3) minimizes mortality. However, patient monitoring could potentially be relaxed at high CD4 count if resources are limited. Optimal ART monitoring strategies in low-income settings remain a research priority. Better understanding of the aetiology of anaemia in patients on AR…
pages: e43375
doi: 10.1371/journal.pone.0043375
citation key: duongLaboratoryClinicalPredictors2012
PMID: 22905264
creator: Person
author list: Person
is part of: Issue
  date: 2012
  volume: 7
  issue: 8
  is part of: PloS one
    type: Journal
    short title: PLoS ONE
    issn: 1932-6203

Person
given name: Trinh
surname: Duong

Person
given name: Gonzague
surname: Jourdain

Person
given name: Nicole
surname: Ngo-Giang-Huong

Person
given name: Sophie
surname: Le Cœur

Person
given name: Pacharee
surname: Kantipong

Person
given name: Sudanee
surname: Buranabanjasatean

Person
given name: Prattana
surname: Leenasirimakul

Person
given name: Sriprapar
surname: Ariyadej

Person
given name: Somboon
surname: Tansuphasawasdikul

Person
given name: Suchart
surname: Thongpaen

Person
given name: Marc
surname: Lallemant