Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Tuboi, Suely Hiromi; Pacheco, Antonio Guilherme; Harrison, Lee H; Stone, Roslyn A; May, Margaret; Brinkhof, Martin W G; Dabis, François; Egger, Matthias; Nash, Denis; Bangsberg, David; Braitstein, Paula; Yiannoutsos, Constantin T; Wood, Robin; Sprinz, Eduardo; Schechter, Mauro (2010). Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings. Journal of acquired immune deficiency syndromes JAIDS, 53(1), pp. 70-77. Philadelphia, Pa.: Lippincott Williams & Wilkins 10.1097/QAI.0b013e3181c22d19

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Objectives: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. Methods: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. Results: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. Conclusions: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Brinkhof, Martin and Egger, Matthias

ISSN:

0894-9255

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:09

Last Modified:

08 Sep 2015 14:24

Publisher DOI:

10.1097/QAI.0b013e3181c22d19

PubMed ID:

20035163

Web of Science ID:

000273182400011

BORIS DOI:

10.7892/boris.1026

URI:

https://boris.unibe.ch/id/eprint/1026 (FactScience: 201699)

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