Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

May, Margaret; Sterne, Jonathan A C; Sabin, Caroline; Costagliola, Dominique; Ac, Justice; Thiébaut, Rodolphe; Gill, John; Phillips, Andrew; Reiss, Peter; Hogg, Robert S.; Ledergerber, Bruno; Monforte, Antonella d’Arminio; Schmeißer, Norbert; Staszewski, Schlomo; Egger, Matthias

doi:10.1097/qad.0b013e328133f285

Cited by 255 publications

(98 citation statements)

References 27 publications

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“…Patients with CD4 cell <200 cells/mm 3 have 3.31 times more hazard to die than patient who had CD4 cell more than 200 cells/mm 3 . The mortality is inversely proportional to CD4 count, cumulative probability of AIDS and death increased substantially with decreasing CD4 cell count Ghate et al (2011;ATCC, 2009;May et al, 2007;Rai et al, 2013;Rajasekaran et al, 2009;Kee et al, 2009). It emphasizes the importance of creating awareness about early diagnosis so that the eligible patients can be initiated on ART earlier.…”

Section: Discussionmentioning

confidence: 99%

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

Swain¹,

Grover²

2016

American Journal of Biostatistics

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Abstract:The main objective of this paper is to identify the independent predictors affecting the survival of HIV/AIDS infected patients on Antiretroviral Therapy (ART), an interval censored event time outcome. A total of 2052 HIV/AIDS patients, who were on ART at Ram ManoharLohia Hospital, New Delhi, India, during the period of April 2004 to December 2010, were included for analysis. Accelerated Failure Time Models (AFTM) viz., exponential, Weibull, lognormal and loglogistic for interval censored survival data, have been used to determine the significant predictors for HIV/AIDS infected patients. The best model is selected on the basis of Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) values. Out of 2052 HIV/AIDS patients 65.4% were males and 34.6% were females. A majority 93.7% of patients had CD4 cell counts below 350 cells/mm 3 at the time of initiation of ART. The mean age of patients at diagnosis was 34.28±8.19 years. The prognostic factorsviz., age, sex, CD4 cell count, past smokers, baseline hemoglobin and baseline BMI are found to be statistically significant (p<0.000) for HIV/AIDS patients on ART. Hence, a special attention is needed for patients with low CD4 cell counts, low BMI and low hemoglobin. Lognormal AFT model is found to be the best model to identify the independent predictors for survival of HIV population.

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Section: Discussionmentioning

confidence: 99%

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

Swain¹,

Grover²

2016

American Journal of Biostatistics

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“…After initiation of ART, disease progression and mortality depend on age and immunological reconstitution [19,24]. Overall mortality was increased among patients who failed to obtain a normal CD4+ T cell count while on therapy [21].…”

Section: Discussionmentioning

confidence: 99%

“…RESINA is a large prospective and well-characterized cohort of HIV-infected patients in North Rhine-Westphalia, Germany [24]. A total of 35 centers contribute by providing patient data for the cohort, which comprised 2,085 patients at the beginning of 2010.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

et al. 2012

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Background: Older HIV patients are defined as aged 50 years and older. This group is a growing population in developed countries. In order to improve care for older HIV patients, we intended to gain insight into the specific features of transmission, epidemiology, immunology and antiretroviral treatment (ART) of this population. Patients and Methods: All patients from the RESINA cohort were analyzed, comprising 2,085 individuals at the beginning of 2010. RESINA is an ongoing study analyzing epidemiological and immunological data, resistance patterns and therapeutic data in treatment-naive HIV-positive patients from North Rhine-Westphalia, Germany. Patients are included in the RESINA cohort at the time of the intended start of ART. For statistical evaluation, we used χ² and Mann-Whitney U tests. Results: A total of 14.6% of patients in our cohort was above 50 years. Men were significantly more prevalent among older patients (86.8 vs. 78.6%; p < 0.001). The proportion of older patients was significantly higher in the heterosexual group (30%) as compared to bisexual (20%), homosexual (13%) and intravenous drug user (4%) modes of transmission (p < 0.001). When comparing ethnic groups, older patients were most often found among Caucasians (17 vs. 4% in other groups, p < 0.001). No significant difference for transmitted drug resistance patterns was found. The proportion of older patients with CDC stage A was significantly lower than with stages B or C (10 vs. 21 vs. 21%, p < 0.001). In older patients, changes of ART regimes were more frequent (p = 0.015) and the median CD4 cell count at the start of treatment was lower (176 vs. 200/µl, p = 0.017). After 72 weeks of ART, the relative increase of CD4 cells was significantly lower in older as compared to younger patients (200 vs. 231/µl, p = 0.017). Conclusions: Our results provide insight into the epidemiology of HIV in the elderly. In our cohort, the typical older patient was a Caucasian male who had acquired HIV through heterosexual contact. The prognosis in older patients is worsened as a result of several unfavorable circumstances, such as delayed start of ART, more frequent treatment changes and diminished immune reconstitution. As a consequence, better strategies for more frequent HIV testing in patients at risk for HIV are needed, and ART should be offered to older patients at earlier time points and higher CD4 cell counts.

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“…Late initiation of antiretroviral therapy (ART) is associated with a diminished response to treatment, 28 and a higher risk for both progression to AIDS and mortality. 29–33 Late HIV diagnosis also has public health implications, since individuals unaware of their HIV status may be more likely to transmit HIV to others.…”

Section: Introductionmentioning

confidence: 99%

Infrequent HIV Testing and Late HIV Diagnosis Are Common Among a Cohort of Black Men Who Have Sex With Men in 6 US Cities

Mannheimer

Wang

Wilton

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective US guidelines recommend at least annual HIV testing for those at risk. This analysis assessed frequency and correlates of infrequent HIV testing and late diagnosis among black men who have sex with men (BMSM). Methods HIV testing history was collected at enrollment from participants in HPTN 061, an HIV prevention trial for at-risk US BMSM. Two definitions of late HIV diagnosis were assessed: CD4 cell count <200 cells/mm3 or <350 cells/mm3 at diagnosis. Results HPTN 061 enrolled 1553 BMSM. HIV testing questions were completed at enrollment by 1284 (98.7%) of 1301 participants with no prior HIV diagnosis; 272 (21.2%) reported no HIV test in prior 12 months (infrequent testing); 155 of whom (12.1% of the 1284 with testing data) reported never testing. Infrequent HIV testing was associated with: not seeing a medical provider in the prior 6 months (relative risk [RR]: 1.08, 95% confidence intervals [CI]: 1.03–1.13), being unemployed (RR 1.04, CI: 1.01–1.07), and having high internalized HIV stigma (RR: 1.03, CI: 1.0–1.05). New HIV diagnoses were more likely among infrequent testers compared to men tested in the prior year (18.4% vs. 4.4%; OR: 4.8, 95% CI: 3.2–7.4). Among men with newly diagnosed HIV, 33 (39.3%) had a CD4 cell count <350 cells/mm;3 including 17 (20.2%) with CD4 <200 cells/mm.3 Conclusions Infrequent HIV testing, undiagnosed infection, and late diagnosis were common among BMSM in this study. New HIV diagnoses were more common among infrequent testers, underscoring the need for additional HIV testing and prevention efforts among US BMSM.

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Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

Cited by 255 publications

References 27 publications

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

Infrequent HIV Testing and Late HIV Diagnosis Are Common Among a Cohort of Black Men Who Have Sex With Men in 6 US Cities

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