Bibliographic Details
| Title: |
Laboratory and clinical predictors of disease progression following initiation of combination therapy in HIV-infected adults in Thailand. |
| Authors: |
Trinh Duong, Gonzague Jourdain, Nicole Ngo-Giang-Huong, Sophie Le Cœur, Pacharee Kantipong, Sudanee Buranabanjasatean, Prattana Leenasirimakul, Sriprapar Ariyadej, Somboon Tansuphasawasdikul, Suchart Thongpaen, Marc Lallemant, Program for HIV Prevention and Treatment Study Group |
| Source: |
PLoS ONE, Vol 7, Iss 8, p e43375 (2012) |
| Publisher Information: |
Public Library of Science (PLoS), 2012. |
| Publication Year: |
2012 |
| Collection: |
LCC:Medicine
LCC:Science |
| Subject Terms: |
Medicine, Science |
| More Details: |
BackgroundData on determinants of long-term disease progression in HIV-infected patients on antiretroviral therapy (ART) are limited in low and middle-income settings.MethodsEffects 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.ResultsAmong 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.ConclusionsPatients 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 ART could guide prevention and treatment. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1932-6203 |
| Relation: |
https://doaj.org/toc/1932-6203 |
| DOI: |
10.1371/journal.pone.0043375 |
| Access URL: |
https://doaj.org/article/ce54462a1a0141ccab82356a7f5993cc |
| Accession Number: |
edsdoj.54462a1a0141ccab82356a7f5993cc |
| Database: |
Directory of Open Access Journals |
