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 Johnson; Mark 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

doi:10.1186/1742-6405-9-4

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

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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 ³before 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 ₁₀increase), 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 language	English (US)
Article number	4
Journal	AIDS Research and Therapy
Volume	9
DOIs	https://doi.org/10.1186/1742-6405-9-4
State	Published - Feb 10 2012

Bibliographical note

Funding Information:
Additional members of the Infectious Disease Clinical Research Program HIV/ STI Working Group include Susan Banks, Mary Bavaro, Helen Chun, Cathy Decker, Connor Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur Johnson, Mark 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, and Michael Zapor. The content and views expressed in this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, the DoD or the Departments of the Army, Navy, Air Force, Department of Defense, nor the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Support for this work (IDCRP-000-14) was provided by the Infectious Disease Clinical Research Program, a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.

Keywords

CD4+ lymphocyte count
Highly active antiretroviral therapy
Mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/1742-6405-9-4

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Lifson, A. R., Krantz, E. M., Grambsch, P. L., Macalino, G. E., Crum-Cianflone, N. F., Ganesan, A., Okulicz, J. F., Eaton, A., Powers, J. H., Eberly, L. E., Agan, B. K., Banks, S., Bavaro, M., Chun, H., Decker, C., Eggleston, C., Fraser, S., Hartzell, J., Hsue, 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, 9, Article 4. https://doi.org/10.1186/1742-6405-9-4

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

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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",

note = "Funding Information: Additional members of the Infectious Disease Clinical Research Program HIV/ STI Working Group include Susan Banks, Mary Bavaro, Helen Chun, Cathy Decker, Connor Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur Johnson, Mark Kortepeter, Tahaniyat Lalani, Michael Landrum, Michelle Linfesty, Scott Merritt, Robert O{\textquoteright}Connell, Sheila Peel, Michael Polis, Roseanne Ressnerk, Edmund Tramont, Tyler Warkentien, Paige Waterman, Amy Weintrob, Timothy Whitman, Glenn Wortmann, and Michael Zapor. The content and views expressed in this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, the DoD or the Departments of the Army, Navy, Air Force, Department of Defense, nor the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Support for this work (IDCRP-000-14) was provided by the Infectious Disease Clinical Research Program, a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.",

year = "2012",

month = feb,

day = "10",

doi = "10.1186/1742-6405-9-4",

language = "English (US)",

volume = "9",

journal = "AIDS Research and Therapy",

issn = "1742-6405",

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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

N1 - Funding Information: Additional members of the Infectious Disease Clinical Research Program HIV/ STI Working Group include Susan Banks, Mary Bavaro, Helen Chun, Cathy Decker, Connor Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur Johnson, Mark 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, and Michael Zapor. The content and views expressed in this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, the DoD or the Departments of the Army, Navy, Air Force, Department of Defense, nor the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Support for this work (IDCRP-000-14) was provided by the Infectious Disease Clinical Research Program, a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.

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

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SN - 1742-6405

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JO - AIDS Research and Therapy

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

Abstract

Bibliographical note

Keywords

UN SDGs

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