Objectives: Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia-Pacific. Methods: PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow-up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow-up as a competing risk. Results: A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first-year mortality rate was 4.27 per 100 person-years (PY). Thirty-eight deaths (52%) were AIDS-related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)-related, 13 (18%) were non-AIDS-related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub-hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60–5.32] compared to BMI 18.5–24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62–23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05–0.26) was associated with reduced hazard for mortality compared to CD4 count ≤ 25 cells/μL. Conclusions: Fifty-two per cent of early deaths were AIDS-related. Efforts to initiate ART at CD4 counts > 50 cell/μL are associated with improved short-term survival rates, even in those with late stages of HIV disease.
|Number of pages||6|
|Publication status||Published - 2020 Jul 1|
Bibliographical noteFunding Information:
The study team would like to acknowledge all TAHOD study members, the steering committee, and patients for their support. The TREAT Asia HIV Observational Database (TAHOD) contributors include: P. S. Ly* and V. Khol, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; F. J. Zhang*†, H. X. Zhao and N. Han, Beijing Ditan Hospital, Capital Medical University, Beijing, China; M. P. Lee*, P. C. K. Li, W. Lam and Y. T. Chan, Queen Elizabeth Hospital, Hong Kong SAR; N. Kumarasamy*, S. Saghayam and C. Ezhilarasi, Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India; S. Pujari*, K. Joshi, S. Gaikwad and A. Chitalikar, Institute of Infectious Diseases, Pune, India; S. Sangle*, V. Mave and I. Marbaniang, BJ Government Medical College and Sassoon General Hospital, Pune, India; T. P. Merati*, D. N. Wirawan and F. Yuliana, Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia; E. Yunihastuti*, D. Imran and A. Widhani, Faculty of Medicine, Universitas Indonesia ‐ Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; J. Tanuma*, S. Oka and T. Nishijima, National Center for Global Health and Medicine, Tokyo, Japan; J. Y. Choi*, S. Na and J. M. Kim, Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; B. L. H. Sim*, Y. M. Gani and N. B. Rudi, Hospital Sungai Buloh, Sungai Buloh, Malaysia; A. Kamarulzaman*, S. F. Syed Omar, S. Ponnampalavanar and I. Azwa, University Malaya Medical Centre, Kuala Lumpur, Malaysia; R. Ditangco*, M. K. Pasayan and M. L. Mationg, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; W. W. Wong*, W. W. Ku and P. C. Wu, Taipei Veterans General Hospital, Taipei, Taiwan; O. T. Ng*‡, P. L. Lim, L. S. Lee and Z. Ferdous, Tan Tock Seng Hospital, Singapore; A. Avihingsanon*, S. Gatechompol, P. Phanuphak and C. Phadungphon, HIV‐NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; S. Kiertiburanakul*, A. Phuphuakrat, L. Chumla and N. Sanmeema, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; R. Chaiwarith*, T. Sirisanthana, W. Kotarathititum and J. Praparattanapan, Research Institute for Health Sciences, Chiang Mai, Thailand; S. Khusuwan*, P. Kantipong and P. Kambua, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; K. V. Nguyen*, H. V. Bui, D. T. H. Nguyen and D. T. Nguyen, National Hospital for Tropical Diseases, Hanoi, Vietnam; C. D. Do*, A. V. Ngo and L. T. Nguyen, Bach Mai Hospital, Hanoi, Vietnam; A. H. Sohn*, J. L. Ross* and B. Petersen, TREAT Asia, amfAR – The Foundation for AIDS Research, Bangkok, Thailand; M. G. Law*, A. Jiamsakul* and D. Rupasinghe, The Kirby Institute, UNSW Sydney, NSW, Australia. *TAHOD Steering Committee member; † Steering Committee Chair; ‡ co‐Chair. Conflicts of interest : The authors have no conflicts of interest to disclose. Financial disclosure : This study was supported by the TREAT Asia HIV Observational Database which is funded by International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above.
© 2019 British HIV Association
All Science Journal Classification (ASJC) codes
- Health Policy
- Infectious Diseases
- Pharmacology (medical)