AEGiS-9CROI: Physician Experience is an Important and Independent Determinant of HIV-Related Mortality among Person Initiating Antiretroviral Therapy.

9th Conference on Retroviruses and Opportunistic Infections


Seattle, Washington - February 24 -February 28, 2002

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Physician Experience is an Important and Independent Determinant of HIV-Related Mortality among Person Initiating Antiretroviral Therapy.

Conf Retroviruses Opportunistic Infect 2002 Feb 24-28;9:abstract no. 749-W
Hogg R, Wood E, Yip B, O'Shaughnessy MV, Montaner JS; British Columbia Ctr. for Excellence in HIV/AIDS, Vancouver, Canada

BACKGROUND: Our objective was to characterize baseline determinants of mortality among persons initiating therapy in a population-based setting.

METHODS: Study participants were antiretroviral naïve and initiated triple drug therapy in British Columbia between August 1, 1996 and September 30, 1999. Cumulative mortality rates were estimated using Kaplan-Meier methods. Cox-proportional hazard regression was used to model the simultaneous effect of prognostic variables on survival. The primary endpoint was HIV-related mortality. Event-free subjects were right censored as of September 30, 2000. The following baseline variables were investigated: age, gender, CD4 cell count, plasma HIV-1-RNA levels, AIDS diagnosis, therapeutic class (PI versus NNRTI), adherence, and physician experience. Adherence was based on medications dispensed and was measured by dividing the number of months of medications dispensed by the number of months of follow-up in the first year. For each subject, physician experience was defined as the cumulative number of HIV+ patients who the physician has previously followed prior to seeing the study participant. All analyses were conducted using intent to treat principles.

RESULTS: Out of the 1219 study participants, 104 (8.5%) had died. Of these deaths, 82 (78.8%) were attributed to HIV-related causes. Cumulative mortality at 12 months for HIV-related deaths was 2.9% + 0.5 In the multivariate model, after controlling for other prognostic explanatory variables that were significant in the univariate analyses, adherence below 75% and physician experience (above first quartile versus below) were associated with increased mortality with risk ratios of 3.83 (95% CI: 2.42, 6.07; p < 0.001) and 0.54 (95% CI: 0.35, 0.84; p = 0.007), respectively. In comparison, those with CD4 cell counts of < 50 cells/ mm(3) were 7.29 (95% CI: 3.88, 13.67; p < 0.001) times more likely to die and those with counts of 50-199 cells/ mm(3) were 3.61 (95% CI: 2.03, 6.43; p < 0.001) times more likely to die than those with CD4 cell counts above 200 cells/ mm(3). The results were unchanged when all cause mortality was the outcome of interest, except that physician experience was no longer significantly associated with all cause mortality.

CONCLUSION: Our data demonstrate that CD4 count, physician experience, and non-adherence to medication in the first year are important predictors of HIV-related mortality.

Keywords: HIV Infections, CD4 Lymphocyte Count, Antiretroviral Therapy, Highly Active, HIV Seropositivity, Survival Rate, Cause of Death, British Columbia, Human, mortality, therapy, drug therapyKWDhivinfections,cd4lymphocytecount,antiretroviraltherapy,highlyactive,hivseropositivity,survivalrate,causeofdeath,britishcolumbia,human,mortality,therapy,drugtherapy

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Copyright © 2002 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.