17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

MORTALITY DURING THE FIRST YEAR OF POTENT ANTIRETROVIRAL THERAPY IN HIV-1-INFECTED PATIENTS FROM 5 TREATMENT CENTERS IN THE CARIBBEAN AND LATIN AMERICA

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0203

S. Tuboi¹, B. Shepherd², C. Cesar³, A. Krolewiecki³, P. Cahn³, M. Wolff⁴, J. Pape⁵, E. Gotuzzo⁶, M. Bacon⁷, C. McGowan⁸, D. Masys⁹, M. Schechter^10
1Universidade Federal do Rio de Janeiro, Projeto Praça Onze, Rio de Janeiro, Brazil, ²University of Vanderbilt, Biostatistics, Nashville, United States, ³Fundacion Huesped, Buenos Aires, Argentina, ⁴University of Chile School of Medicine, Medicine, Santiago, Chile, ⁵GHESKIO/Weill Medical College of Cornell University, Port-au-Prince, Haiti, ⁶Instituto de Medicina Tropical, Lima, Peru, ⁷HJF-NIAID/DAIDS, Epidemiology, Bethesda, United States, ⁸University of Vanderbilt, Infectious Diseases, Nashville, United States, ⁹University of Vanderbilt, Biomedical Informatics, Nashville, United States, ¹⁰Universidade Federal do Rio de Janeiro, Departamento de Medicina Preventiva, Rio de Janeiro, Brazil

BACKGROUND: Approximately 2.1 million people are HIV positive in Latin America and the Caribbean. No multi-cohort study has studied comparative mortality rates and risk factors after HAART initiation in this region.

METHODS: Antiretroviral-naïve patients aged ≥18 years who started HAART between March 1996 and April 2007 from sites in Argentina, Brazil, Chile, Haiti, and Peru were included. Association between independent variables and outcome was assessed by Cox regression models. Data were censored at the earliest of death, latest follow-up visit, or 365 days.

RESULTS: Of 4503 HIV-infected patients initiating HAART, 37% were female, and the median age was 37 yrs (interquartile range [IQR], 31-44). The median baseline CD4 count was 109 cells/mm³ (IQR, 38-204) and varied between sites (163, 162, 116, 102, and 79 for Argentina, Brazil, Chile, Haiti, and Peru, respectively). The 1-year probability of death for the combined cohort was 8.2% (95%CI 7.4-9.1%) and varied across sites: 2.4% for Argentina; 3.7% for Brazil, 6.0% for Chile, 12% for Haiti, and 9.8% for Peru. Multivariable analysis adjusting for sex, age, clinical stage, calendar year, and type of regimen showed that hazard of death was associated with lower CD4 count at HAART initiation [HRs compared to CD4=50 cells/mm³: 0.7 (95%CI 0.62-0.85) for CD4=100; 0.49 (95%CI 0.29-0.71) for CD4=200; and 0.28 (95%CI 0.15-0.69) for CD4=350], AIDS at HAART initiation (HR 3.2; 95%CI 1.8-5.7), and older age (HR=1.13 per 10 years; 95%CI 0.99-1.29).

CONCLUSION: The overall one-year mortality rate and risk factors for death observed in this region were similar to that reported for lower income countries. Possible explanations for the high variability observed across sites are different stages of disease at HAART initiation because of late presentation, different criteria for HAART eligibility, differing rates of loss to follow up, age of ARV program, and background co-morbid conditions.

Download PDF of this abstract.

2008-08-13
MOAB0203

Copyright © 2008 - International AIDS Society (IAS). All information and content relating to the abstracts from the 16th International AIDS Conference, such as text, graphics, logos, button icons, images, audio clips, and software is protected by copyright. Permission is hereby granted for the non-commercial use or reproduction of the information on this web site, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.

AEGiS is a 501c(3) not-for-profit organization made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, GlaxoSmithKline, the National Library of Medicine, Roche / Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2008. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. Permission is hereby granted for the non-commercial use or reproduction of the information herein, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.