Effect of macrolide prophylactic therapy on AIDS-Defining conditions and HIV-Associated mortality

Mark Kristoffer U. Pasayan, Mary Lorraine S. Mationg, David Boettiger, Wilson Lam, Fujie Zhang, Stephane Wen Wei Ku, Tuti Parwati Merati, Romanee Chaiwarith, Do Duy Cuong, Evy Yunihastuti, Sasisopin Kiertiburanakul, Nguyen Van Kinh, Anchalee Avihingsanon, Ly Penh Sun, Adeeba Kamarulzaman, Pacharee Kantipong, Nagalingeswaran Kumarasamy, Sanjay Pujari, Benedict Lim Heng Sim, Oon Tek NgJun Yong Choi, Junko Tanuma, Jeremy Ross, Rossana A. Ditangco

Research output: Contribution to journalArticle

Abstract

Background:Mycobacterium avium complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated Mycobacterium avium complex infection and the availability of antiretroviral therapy (ART), the benefits of macrolide prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.Methods:Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count <50 cells/mm3 at ART initiation were included. The effect of macrolide prophylaxis on HIV-associated mortality or AIDS-defining conditions (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted in patients with a CD4 <100 cells/mm3 at ART initiation.Results:Of 1345 eligible patients, 10.6% received macrolide prophylaxis. The rate of the combined outcome was 7.35 [95% confidence interval (CI): 6.04 to 8.95] per 100 patient-years, whereas the rate of HIV-associated mortality was 3.14 (95% CI: 2.35 to 4.19) per 100 patient-years. Macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio 0.10, 95% CI: 0.01 to 0.80, P = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, P = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 <100 cells/mm3 at ART initiation.Conclusions:Macrolide prophylaxis is associated with improved survival among Asian HIV-infected patients with low CD4 cell counts and on ART. This study suggests the increased usage and coverage of macrolide prophylaxis among people living with HIV in Asia.

Original languageEnglish
Pages (from-to)436-443
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume80
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

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    Pasayan, M. K. U., Mationg, M. L. S., Boettiger, D., Lam, W., Zhang, F., Ku, S. W. W., Merati, T. P., Chaiwarith, R., Cuong, D. D., Yunihastuti, E., Kiertiburanakul, S., Van Kinh, N., Avihingsanon, A., Sun, L. P., Kamarulzaman, A., Kantipong, P., Kumarasamy, N., Pujari, S., Heng Sim, B. L., ... Ditangco, R. A. (2019). Effect of macrolide prophylactic therapy on AIDS-Defining conditions and HIV-Associated mortality. Journal of Acquired Immune Deficiency Syndromes, 80(4), 436-443. https://doi.org/10.1097/QAI.0000000000001933