Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings
Tuboi, S.Hiromi.; Pacheco, A.Guilherme.; Harrison, L.H.; Stone, R.A.; May, M.; Brinkhof, M.W.G.; Dabis, Fçois.; Egger, M.; Nash, D.; Bangsberg, D.; Braitstein, P.; Yiannoutsos, C.T.; Wood, R.; Sprinz, E.; Schechter, M.; Balestre, E.; Brinkhof, M.; Dabis, Fçois.; Egger, M.; Graber, C.; Fatzer, B.; Keiser, O.; Lewden, C.; Pujades, M.; Schechter, M.
Journal of Acquired Immune Deficiency Syndromes 53(1): 70-77
2010
ISSN/ISBN: 1525-4135 PMID: 20035163 DOI: 10.1097/qai.0b013e3181c22d19Document Number: 209011
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. 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. 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. 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.