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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

Rupasinghe D 1 , Kiertiburanakul S 2 , Kamarulzaman A 3 , Zhang F 4 , Kumarasamy N 5 , Chaiwarith R 6 Show all authors , Merati TP 7 , Do CD 8 , Khusuwan S 9 , Avihingsanon A 10 , Lee MP 11 , Ly PS 12 , Yunihastuti E 13 , Nguyen KV 14 , Ditangco R 15 , Chan YJ 16 , Pujari S 17 , Ng OT 18 , Choi JY 19 , Sim B 20 , Tanuma J 21 , Sangle S 22 , Ross J 23 , Law M 1

Affiliations 

  • 1 The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
  • 2 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 3 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 4 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 5 CART CRS, Voluntary Health Services, Chennai, India
  • 6 Research Institute for Health Sciences, Chiang Mai, Thailand
  • 7 Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
  • 8 Bach Mai Hospital, Hanoi, Vietnam
  • 9 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 10 HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 11 Queen Elizabeth Hospital, Hong Kong SAR, China
  • 12 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
  • 13 Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 14 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 15 Research Institute for Tropical Medicine, Muntinlupa City, Philippines
  • 16 Taipei Veterans General Hospital, Taipei, Taiwan
  • 17 Institute of Infectious Diseases, Pune, India
  • 18 Tan Tock Seng Hospital, Singapore City, Singapore
  • 19 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 National Center for Global Health and Medicine, Tokyo, Japan
  • 22 BJ Government Medical College and Sassoon General Hospitals, Pune, India
  • 23 TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand
HIV Med, 2020 07;21(6):397-402.
PMID: 31852025 DOI: 10.1111/hiv.12836

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  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)  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 > 50 cell/μL are associated with improved short-term survival rates, even in those with late stages of HIV disease.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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