Mortality in the Highly Active Antiretroviral Therapy Era

Palella, Frank J.; Baker, Rose K.; Moorman, Anne C.; Chmiel, Joan S.; Wood, Kathy; Brooks, John T.; Holmberg, Scott D.

doi:10.1097/01.qai.0000233310.90484.16

Cited by 1,217 publications

(391 citation statements)

References 28 publications

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“…We then categorized eGFR (<30, 30-45, 45-60, 60-80, >80 mL/min/1.73m 2 ) using the MDRD equation stratified by race, and then repeated the categories using the MDRD-RCR. Next, we compared baseline clinical characteristics of Blacks, stratified by eGFR category: <60, 60-72, and >72 mL/min/1.73m 2 . We specifically distinguished the 60-72mL/ min/1.73m 2 category, as these Blacks are the ones re-classified to eGFR<60 mL/ min/1.73m 2 when the race coefficient is removed from the MDRD equation.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Recent studies have shown a large disparity in prevalence and incidence of end stage renal disease (ESRD) by race among persons with HIV. [3][4][5] Despite Blacks with HIV-infection having a higher incidence of ESRD and higher prevalence of known CKD risk factors compared with Whites, 4,[6][7][8][9][10] the prevalence of reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73m 2 ) is similar between Whites and Blacks with HIV. 11 One possible explanation for this observation is that Blacks with HIV may have rapidly progressive CKD leading to a lower prevalence of mildly reduced GFR among Blacks.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Anker¹,

Scherzer²,

Peralta³

et al. 2016

Ethn Dis

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Objective: The aim of our study was to investigate whether current eGFR equations in clinical use might systematically overestimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality.Design: Retrospective cohort study.Setting: The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally.Patients/Participants: 21,905 treatmentnaïve HIV-infected veterans.Main Outcome Measures: Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and allcause mortality.Results: Persons with eGFR <45 mL/ min/1.73m2 had a higher risk of death compared with those with eGFR >80 mL/ min/1.73m2 among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45- 60 mL/min/1.73m2 also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=0.86, 95%CI: .67- 1.10; test for interaction: P<.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient.Conclusions: Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV. Ethn Dis. 2016;26(2):213-220; doi:10.18865/ ed.26.2.213

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Anker¹,

Scherzer²,

Peralta³

et al. 2016

Ethn Dis

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“…However, while there has been a marked reduction in HIV-related mortality and morbidity [2,3], additional challenges have emerged in the long-term management of HIV, such as drug toxicities [4-6], treatment failure due to poor adherence [7,8] and/or drug resistance [9] requiring regimen change, and increasing non-HIV-related morbidity and mortality [10-12]. As with any chronic illness, HIV patients require long-term, regular clinical follow up to monitor disease progression and optimal timing of initiation of HAART, assess response and adherence to antiretroviral therapy and associated adverse events, and address sexual health and HIV prevention needs [13].…”

Section: Introductionmentioning

confidence: 99%

High rate of loss to clinical follow up among African HIV-infected patients attending a London clinic: a retrospective analysis of a clinical cohort

Gerver

Chadborn²,

Ibrahim

et al. 2010

Journal of the International AIDS Society

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BackgroundLong-term regular clinic follow up is an important component of HIV care. We determined the frequency and characteristics of HIV-infected patients lost to follow up from a London HIV clinic, and factors associated with loss to all HIV follow up in the UK.MethodsWe identified 1859 HIV-infected adults who had registered and attended a London clinic on one or more occasions between January 1997 and December 2005. Loss to follow up was defined as clinic non-attendance for one or more years. Through anonymized linkage with the Survey of Prevalent HIV Infections Diagnosed and Health Protection Scotland, national databases of all HIV patients in care in the UK up to December 2006, loss-to-follow-up patients were categorized as Transfers (subsequently received care at another UK HIV clinic) or UKLFU (no record of subsequent attendance at any HIV clinic in the UK). Logistic regression analysis was used to identify factors associated with UKLFU for those both on highly active antiretroviral therapy (HAART) and not on HAART.ResultsIn total, 722 (38.8%) of 1859 patients were defined as lost to follow up. Of these, 347 (48.1%) were Transfers and 375 (51.9%), or 20.2% of all patients, were UKLFU. Overall, 11.9% of all patients receiving HAART, and 32.2% not receiving HAART were UKLFU. Among those on HAART, risk factors for UKLFU were: African heterosexual female (OR = 2.22, 95% CI: 1.11-4.56) versus white men who have sex with men; earlier year of HIV clinic registration (1997-1999 OR: 3.51, 95% CI: 1.97-6.26; 2000-02 OR: 2.49, 95% CI: 1.43-4.32 vs. 2003-2005); CD4 count of < 200 versus > 350 cells/mm3 (OR = 1.99, 95% CI:1.05-3.74); and a detectable viral load of > 400 copies/ml (OR = 5.03, 95% CI: 2.95-8.57 vs. ≤ 400 copies/ml) at last clinic visit.Among those not receiving HAART, factors were: African heterosexual male (OR = 3.91, 95% CI: 1.77-8.64) versus white men who have sex with men; earlier HIV clinic registration (2000-2002 OR: 2.91, 95% CI: 1.77-4.78; 1997-1999: OR: 5.26, 95% CI: 2.71-10.19); and a CD4 count of < 200 cells/mm3 (OR: 3.24, 95% CI: 1.49-7.04).ConclusionsOne in five HIV-infected patients (one in three not on HAART and one in nine on HAART) from a London clinic were lost to all clinical follow up in the UK. Black African ethnicity, earlier year of clinic registration and advanced immunological suppression were the most important predictors of UKLFU. There is a need for all HIV clinics to establish systems for monitoring and tracing loss-to-follow-up patients, and to implement strategies for improving retention in care.

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“…En el manejo a largo plazo del paciente con HIV, han surgido retos adicionales como la toxicidad de los medicamentos (4,5), el fracaso del tratamiento debido a un cumplimiento inadecuado (6,7), la resistencia a los medicamentos antirretrovirales (8) con el consecuente cambio en el esquema de tratamiento, y un incremento en la morbilidad y la mortalidad no asociadas al HIV (9,10). Los pacientes con HIV requieren un seguimiento clínico prolongado para vigilar la progresión de la enfermedad y determinar el momento oportuno para iniciar el tratamiento y para evaluar la respuesta terapéutica, el cumplimiento del tratamiento antirretroviral y los efectos secundarios, y para abordar los aspectos de salud sexual y las necesidades de prevención del HIV (11).…”

unclassified

Pérdida de seguimiento y factores asociados en pacientes inscritos en el programa de HIV/sida del Hospital Universitario San Ignacio, Colombia, 2012-2013

Támara

Rodríguez

2016

biomedica

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Introducción. El seguimiento clínico regular a largo plazo, es un componente importante en la atención de los pacientes con HIV. Objetivo. Describir las razones de la pérdida de seguimiento de los pacientes inscritos en el programa de HIV/sida de un hospital universitario. Materiales y métodos. Se hizo un estudio de casos y controles anidado en una cohorte retrospectiva, entre el 1º de enero de 2012 y el 31 de julio de 2013. Resultados. Se seleccionaron 45 pacientes; la tasa de densidad de incidencia de los pacientes que se perdieron en el seguimiento fue de 17,7 por 100 pacientes por año. En el análisis bivariado, el desempleo (p=0,000), el consumo de alcohol (p=0,004), el tiempo de la evolución de la enfermedad en años (p=0,032), el sexo (p=0,027), y la edad promedio de 34 años (p=0,000) fueron estadísticamente significativos en relación con la pérdida de seguimiento. Al hacer el ajuste por regresión logística para la probabilidad de pérdida de seguimiento, se evidenció que las variables de edad promedio de 34 años (p=0,019; IC95% 0,871-0,976), sexo femenino (p=0,017; IC95% 1,903-31,83), consumo de alcohol (p=0,028; IC95% 0,040-0,830) y desempleo (p=0,001; IC95% 4,696-464,692) tuvieron significación estadística. Conclusiones. Es necesario que los programas de HIV/sida establezcan sistemas de seguimiento y rastreo, con el fin de establecer estrategias para mejorar la retención de los pacientes y, por ende, su calidad de vida a largo plazo.

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Mortality in the Highly Active Antiretroviral Therapy Era

Cited by 1,217 publications

References 28 publications

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

High rate of loss to clinical follow up among African HIV-infected patients attending a London clinic: a retrospective analysis of a clinical cohort

Pérdida de seguimiento y factores asociados en pacientes inscritos en el programa de HIV/sida del Hospital Universitario San Ignacio, Colombia, 2012-2013

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