Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort

Alan R. Lifson, Elizabeth M. Krantz, Patricia L. Grambsch, Grace E. Macalino, Nancy F. Crum-Cianflone, Anuradha Ganesan, Jason F. Okulicz, Anne Eaton, John H. Powers, Lynn E. Eberly, Brian K. Agan, Susan Banks, Mary Bavaro, Helen Chun, Cathy Decker, Connor Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur JohnsonMark Kortepeter, Tahaniyat Lalani, Michael Landrum, Michelle Linfesty, Scott Merritt, Robert O'Connell, Sheila Peel, Michael Polis, Roseanne Ressnerk, Edmund Tramont, Tyler Warkentien, Paige Waterman, Amy Weintrob, Timothy Whitman, Glenn Wortmann, Michael Zapor

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.

Original languageEnglish (US)
Article number4
JournalAIDS Research and Therapy
Volume9
DOIs
StatePublished - Feb 10 2012

Fingerprint

Highly Active Antiretroviral Therapy
Demography
HIV
Survival
Mortality
CD4 Lymphocyte Count
RNA
Hepatitis C Antibodies
Military Personnel
Chronic Hepatitis B
Counseling
Acquired Immunodeficiency Syndrome
Hemoglobins
Multivariate Analysis

Keywords

  • CD4+ lymphocyte count
  • Highly active antiretroviral therapy
  • Mortality

ASJC Scopus subject areas

  • Molecular Medicine
  • Virology
  • Pharmacology (medical)

Cite this

Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort. / Lifson, Alan R.; Krantz, Elizabeth M.; Grambsch, Patricia L.; Macalino, Grace E.; Crum-Cianflone, Nancy F.; Ganesan, Anuradha; Okulicz, Jason F.; Eaton, Anne; Powers, John H.; Eberly, Lynn E.; Agan, Brian K.; Banks, Susan; Bavaro, Mary; Chun, Helen; Decker, Cathy; Eggleston, Connor; Fraser, Susan; Hartzell, Joshua; Hsue, Gunther; Johnson, Arthur; Kortepeter, Mark; Lalani, Tahaniyat; Landrum, Michael; Linfesty, Michelle; Merritt, Scott; O'Connell, Robert; Peel, Sheila; Polis, Michael; Ressnerk, Roseanne; Tramont, Edmund; Warkentien, Tyler; Waterman, Paige; Weintrob, Amy; Whitman, Timothy; Wortmann, Glenn; Zapor, Michael.

In: AIDS Research and Therapy, Vol. 9, 4, 10.02.2012.

Research output: Contribution to journalArticle

Lifson, AR, Krantz, EM, Grambsch, PL, Macalino, GE, Crum-Cianflone, NF, Ganesan, A, Okulicz, JF, Eaton, A, Powers, JH, Eberly, LE, Agan, BK, Banks, S, Bavaro, M, Chun, H, Decker, C, Eggleston, C, Fraser, S, Hartzell, J, Hsue, G, Johnson, A, Kortepeter, M, Lalani, T, Landrum, M, Linfesty, M, Merritt, S, O'Connell, R, Peel, S, Polis, M, Ressnerk, R, Tramont, E, Warkentien, T, Waterman, P, Weintrob, A, Whitman, T, Wortmann, G & Zapor, M 2012, 'Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort', AIDS Research and Therapy, vol. 9, 4. https://doi.org/10.1186/1742-6405-9-4
Lifson, Alan R. ; Krantz, Elizabeth M. ; Grambsch, Patricia L. ; Macalino, Grace E. ; Crum-Cianflone, Nancy F. ; Ganesan, Anuradha ; Okulicz, Jason F. ; Eaton, Anne ; Powers, John H. ; Eberly, Lynn E. ; Agan, Brian K. ; Banks, Susan ; Bavaro, Mary ; Chun, Helen ; Decker, Cathy ; Eggleston, Connor ; Fraser, Susan ; Hartzell, Joshua ; Hsue, Gunther ; Johnson, Arthur ; Kortepeter, Mark ; Lalani, Tahaniyat ; Landrum, Michael ; Linfesty, Michelle ; Merritt, Scott ; O'Connell, Robert ; Peel, Sheila ; Polis, Michael ; Ressnerk, Roseanne ; Tramont, Edmund ; Warkentien, Tyler ; Waterman, Paige ; Weintrob, Amy ; Whitman, Timothy ; Wortmann, Glenn ; Zapor, Michael. / Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort. In: AIDS Research and Therapy. 2012 ; Vol. 9.
@article{c28927887f174e738f3a5aaba6df0e82,
title = "Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort",
abstract = "Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5{\%}, 10{\%} and 18{\%} at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.",
keywords = "CD4+ lymphocyte count, Highly active antiretroviral therapy, Mortality",
author = "Lifson, {Alan R.} and Krantz, {Elizabeth M.} and Grambsch, {Patricia L.} and Macalino, {Grace E.} and Crum-Cianflone, {Nancy F.} and Anuradha Ganesan and Okulicz, {Jason F.} and Anne Eaton and Powers, {John H.} and Eberly, {Lynn E.} and Agan, {Brian K.} and Susan Banks and Mary Bavaro and Helen Chun and Cathy Decker and Connor Eggleston and Susan Fraser and Joshua Hartzell and Gunther Hsue and Arthur Johnson and Mark Kortepeter and Tahaniyat Lalani and Michael Landrum and Michelle Linfesty and Scott Merritt and Robert O'Connell and Sheila Peel and Michael Polis and Roseanne Ressnerk and Edmund Tramont and Tyler Warkentien and Paige Waterman and Amy Weintrob and Timothy Whitman and Glenn Wortmann and Michael Zapor",
year = "2012",
month = "2",
day = "10",
doi = "10.1186/1742-6405-9-4",
language = "English (US)",
volume = "9",
journal = "AIDS Research and Therapy",
issn = "1742-6405",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort

AU - Lifson, Alan R.

AU - Krantz, Elizabeth M.

AU - Grambsch, Patricia L.

AU - Macalino, Grace E.

AU - Crum-Cianflone, Nancy F.

AU - Ganesan, Anuradha

AU - Okulicz, Jason F.

AU - Eaton, Anne

AU - Powers, John H.

AU - Eberly, Lynn E.

AU - Agan, Brian K.

AU - Banks, Susan

AU - Bavaro, Mary

AU - Chun, Helen

AU - Decker, Cathy

AU - Eggleston, Connor

AU - Fraser, Susan

AU - Hartzell, Joshua

AU - Hsue, Gunther

AU - Johnson, Arthur

AU - Kortepeter, Mark

AU - Lalani, Tahaniyat

AU - Landrum, Michael

AU - Linfesty, Michelle

AU - Merritt, Scott

AU - O'Connell, Robert

AU - Peel, Sheila

AU - Polis, Michael

AU - Ressnerk, Roseanne

AU - Tramont, Edmund

AU - Warkentien, Tyler

AU - Waterman, Paige

AU - Weintrob, Amy

AU - Whitman, Timothy

AU - Wortmann, Glenn

AU - Zapor, Michael

PY - 2012/2/10

Y1 - 2012/2/10

N2 - Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.

AB - Background: Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.Methods: We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.Results: Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm 3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm 3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm 3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log 10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.Conclusions: Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.

KW - CD4+ lymphocyte count

KW - Highly active antiretroviral therapy

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=84856802811&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856802811&partnerID=8YFLogxK

U2 - 10.1186/1742-6405-9-4

DO - 10.1186/1742-6405-9-4

M3 - Article

C2 - 22339893

AN - SCOPUS:84856802811

VL - 9

JO - AIDS Research and Therapy

JF - AIDS Research and Therapy

SN - 1742-6405

M1 - 4

ER -