Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia‐Pacific

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...

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Published in:HIV medicine 2020-07, Vol.21 (6), p.397-402
Main Authors: Rupasinghe, D, Kiertiburanakul, S, Kamarulzaman, A, Zhang, F, Kumarasamy, N, Chaiwarith, R, Merati, TP, Do, CD, Khusuwan, S, Avihingsanon, A, Lee, MP, Ly, PS, Yunihastuti, E, Nguyen, KV, Ditangco, R, Chan, YJ, Pujari, S, Ng, OT, Choi, JY, Sim, BLH, Tanuma, J, Sangle, S, Ross, J, Law, M
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
advanced disease
AIDS
Alanine
Alanine transaminase
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Asia‐Pacific
Body mass
Body mass index
Body size
CD4 antigen
Confidence intervals
Drug therapy
Epidemiology
Fatalities
Health hazards
Health risks
HIV
Human immunodeficiency virus
Inflammation
Mortality
Regression analysis
Risk analysis
Risk factors
Statistical analysis
Survival
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cited_by cdi_FETCH-LOGICAL-c3886-afaa90fb87edb1213ab0f79dbdf8df10aa0993f94a83c48cd8b10b3421e29efd3
cites cdi_FETCH-LOGICAL-c3886-afaa90fb87edb1213ab0f79dbdf8df10aa0993f94a83c48cd8b10b3421e29efd3
container_end_page 402
container_issue 6
container_start_page 397
container_title HIV medicine
container_volume 21
creator Rupasinghe, D
Kiertiburanakul, S
Kamarulzaman, A
Zhang, F
Kumarasamy, N
Chaiwarith, R
Merati, TP
Do, CD
Khusuwan, S
Avihingsanon, A
Lee, MP
Ly, PS
Yunihastuti, E
Nguyen, KV
Ditangco, R
Chan, YJ
Pujari, S
Ng, OT
Choi, JY
Sim, BLH
Tanuma, J
Sangle, S
Ross, J
Law, M
description 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  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)  50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.
doi_str_mv 10.1111/hiv.12836
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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 &lt; 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 &gt; 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) &lt; 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 &lt; 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and &gt; 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 &gt; 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.</description><identifier>ISSN: 1464-2662</identifier><identifier>EISSN: 1468-1293</identifier><identifier>DOI: 10.1111/hiv.12836</identifier><identifier>PMID: 31852025</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Acquired immune deficiency syndrome ; advanced disease ; AIDS ; Alanine ; Alanine transaminase ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Asia‐Pacific ; Body mass ; Body mass index ; Body size ; CD4 antigen ; Confidence intervals ; Drug therapy ; Epidemiology ; Fatalities ; Health hazards ; Health risks ; HIV ; Human immunodeficiency virus ; Inflammation ; Mortality ; Regression analysis ; Risk analysis ; Risk factors ; Statistical analysis ; Survival</subject><ispartof>HIV medicine, 2020-07, Vol.21 (6), p.397-402</ispartof><rights>2019 British HIV Association</rights><rights>2019 British HIV Association.</rights><rights>HIV Medicine © 2020 British HIV Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3886-afaa90fb87edb1213ab0f79dbdf8df10aa0993f94a83c48cd8b10b3421e29efd3</citedby><cites>FETCH-LOGICAL-c3886-afaa90fb87edb1213ab0f79dbdf8df10aa0993f94a83c48cd8b10b3421e29efd3</cites><orcidid>0000-0003-3222-9611 ; 0000-0002-4014-3570</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31852025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rupasinghe, D</creatorcontrib><creatorcontrib>Kiertiburanakul, S</creatorcontrib><creatorcontrib>Kamarulzaman, A</creatorcontrib><creatorcontrib>Zhang, F</creatorcontrib><creatorcontrib>Kumarasamy, N</creatorcontrib><creatorcontrib>Chaiwarith, R</creatorcontrib><creatorcontrib>Merati, TP</creatorcontrib><creatorcontrib>Do, CD</creatorcontrib><creatorcontrib>Khusuwan, S</creatorcontrib><creatorcontrib>Avihingsanon, A</creatorcontrib><creatorcontrib>Lee, MP</creatorcontrib><creatorcontrib>Ly, PS</creatorcontrib><creatorcontrib>Yunihastuti, E</creatorcontrib><creatorcontrib>Nguyen, KV</creatorcontrib><creatorcontrib>Ditangco, R</creatorcontrib><creatorcontrib>Chan, YJ</creatorcontrib><creatorcontrib>Pujari, S</creatorcontrib><creatorcontrib>Ng, OT</creatorcontrib><creatorcontrib>Choi, JY</creatorcontrib><creatorcontrib>Sim, BLH</creatorcontrib><creatorcontrib>Tanuma, J</creatorcontrib><creatorcontrib>Sangle, S</creatorcontrib><creatorcontrib>Ross, J</creatorcontrib><creatorcontrib>Law, M</creatorcontrib><title>Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia‐Pacific</title><title>HIV medicine</title><addtitle>HIV Med</addtitle><description>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 &lt; 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 &gt; 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) &lt; 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 &lt; 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and &gt; 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 &gt; 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.</description><subject>Acquired immune deficiency syndrome</subject><subject>advanced disease</subject><subject>AIDS</subject><subject>Alanine</subject><subject>Alanine transaminase</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Asia‐Pacific</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>CD4 antigen</subject><subject>Confidence intervals</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Fatalities</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Inflammation</subject><subject>Mortality</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Survival</subject><issn>1464-2662</issn><issn>1468-1293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1DAUhiMEohdY8ALIEpuZRVpf0sRZRp3ARKo0CAa20UliU1dOPNjOVNnxCH0tXoMnwZlpu0DCG5_F9__H1hdF7wi-IOFc3qr9BaGcpS-iU5KkPCY0Zy8PcxLTNKUn0ZlzdxiTjOX4dXTCCL-imF6dRr9LsHpCvbEetPITAumFRRq8QGpQXoFXZkBGIhi8ssJbs1cWNPK3wsJuCtA8ou2XstiiwilA6-o72jRO2P0hG9gVeGjACbTYFuvNajnXzaFqCLuGJ6rcqU70ymjzQ7XPGYe8QeUe9Dg_qahWX9GiEquyWB62_fn18BlaJVX7JnolQTvx9vE-j759LLfX6_hm86m6Lm7ilnGexiABciwbnomuIZQwaLDM8q7pJO8kwQA4z5nME-CsTXjb8YbghiWUCJoL2bHzaHHs3VnzcxTO171yrdAaBmFGV1NGeZZlmLGAfvgHvTNj-LAOVEJYwjHJk0Atj1RrjXNWyHpnVQ92qgmuZ7918Fsf_Ab2_WPj2PSieyafhAbg8gjcKy2m_zfVwdKx8i9Mo7Gl</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Rupasinghe, D</creator><creator>Kiertiburanakul, S</creator><creator>Kamarulzaman, A</creator><creator>Zhang, F</creator><creator>Kumarasamy, N</creator><creator>Chaiwarith, R</creator><creator>Merati, TP</creator><creator>Do, CD</creator><creator>Khusuwan, S</creator><creator>Avihingsanon, A</creator><creator>Lee, MP</creator><creator>Ly, PS</creator><creator>Yunihastuti, E</creator><creator>Nguyen, KV</creator><creator>Ditangco, R</creator><creator>Chan, YJ</creator><creator>Pujari, S</creator><creator>Ng, OT</creator><creator>Choi, JY</creator><creator>Sim, BLH</creator><creator>Tanuma, J</creator><creator>Sangle, S</creator><creator>Ross, J</creator><creator>Law, M</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3222-9611</orcidid><orcidid>https://orcid.org/0000-0002-4014-3570</orcidid></search><sort><creationdate>202007</creationdate><title>Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia‐Pacific</title><author>Rupasinghe, D ; Kiertiburanakul, S ; Kamarulzaman, A ; Zhang, F ; Kumarasamy, N ; Chaiwarith, R ; Merati, TP ; Do, CD ; Khusuwan, S ; Avihingsanon, A ; Lee, MP ; Ly, PS ; Yunihastuti, E ; Nguyen, KV ; Ditangco, R ; Chan, YJ ; Pujari, S ; Ng, OT ; Choi, JY ; Sim, BLH ; Tanuma, J ; Sangle, S ; Ross, J ; Law, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3886-afaa90fb87edb1213ab0f79dbdf8df10aa0993f94a83c48cd8b10b3421e29efd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>advanced disease</topic><topic>AIDS</topic><topic>Alanine</topic><topic>Alanine transaminase</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Asia‐Pacific</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>CD4 antigen</topic><topic>Confidence intervals</topic><topic>Drug therapy</topic><topic>Epidemiology</topic><topic>Fatalities</topic><topic>Health hazards</topic><topic>Health risks</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Inflammation</topic><topic>Mortality</topic><topic>Regression analysis</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Statistical analysis</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rupasinghe, D</creatorcontrib><creatorcontrib>Kiertiburanakul, S</creatorcontrib><creatorcontrib>Kamarulzaman, A</creatorcontrib><creatorcontrib>Zhang, F</creatorcontrib><creatorcontrib>Kumarasamy, N</creatorcontrib><creatorcontrib>Chaiwarith, R</creatorcontrib><creatorcontrib>Merati, TP</creatorcontrib><creatorcontrib>Do, CD</creatorcontrib><creatorcontrib>Khusuwan, S</creatorcontrib><creatorcontrib>Avihingsanon, A</creatorcontrib><creatorcontrib>Lee, MP</creatorcontrib><creatorcontrib>Ly, PS</creatorcontrib><creatorcontrib>Yunihastuti, E</creatorcontrib><creatorcontrib>Nguyen, KV</creatorcontrib><creatorcontrib>Ditangco, R</creatorcontrib><creatorcontrib>Chan, YJ</creatorcontrib><creatorcontrib>Pujari, S</creatorcontrib><creatorcontrib>Ng, OT</creatorcontrib><creatorcontrib>Choi, JY</creatorcontrib><creatorcontrib>Sim, BLH</creatorcontrib><creatorcontrib>Tanuma, J</creatorcontrib><creatorcontrib>Sangle, S</creatorcontrib><creatorcontrib>Ross, J</creatorcontrib><creatorcontrib>Law, M</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>HIV medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rupasinghe, D</au><au>Kiertiburanakul, S</au><au>Kamarulzaman, A</au><au>Zhang, F</au><au>Kumarasamy, N</au><au>Chaiwarith, R</au><au>Merati, TP</au><au>Do, CD</au><au>Khusuwan, S</au><au>Avihingsanon, A</au><au>Lee, MP</au><au>Ly, PS</au><au>Yunihastuti, E</au><au>Nguyen, KV</au><au>Ditangco, R</au><au>Chan, YJ</au><au>Pujari, S</au><au>Ng, OT</au><au>Choi, JY</au><au>Sim, BLH</au><au>Tanuma, J</au><au>Sangle, S</au><au>Ross, J</au><au>Law, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia‐Pacific</atitle><jtitle>HIV medicine</jtitle><addtitle>HIV Med</addtitle><date>2020-07</date><risdate>2020</risdate><volume>21</volume><issue>6</issue><spage>397</spage><epage>402</epage><pages>397-402</pages><issn>1464-2662</issn><eissn>1468-1293</eissn><abstract>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 &lt; 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 &gt; 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) &lt; 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 &lt; 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and &gt; 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 &gt; 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31852025</pmid><doi>10.1111/hiv.12836</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3222-9611</orcidid><orcidid>https://orcid.org/0000-0002-4014-3570</orcidid><oa>free_for_read</oa></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects Acquired immune deficiency syndrome
advanced disease
AIDS
Alanine
Alanine transaminase
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Asia‐Pacific
Body mass
Body mass index
Body size
CD4 antigen
Confidence intervals
Drug therapy
Epidemiology
Fatalities
Health hazards
Health risks
HIV
Human immunodeficiency virus
Inflammation
Mortality
Regression analysis
Risk analysis
Risk factors
Statistical analysis
Survival
title Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia‐Pacific
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