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Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Copyright © 2009 by Lippincott Williams & Wilkins.
Original language | English |
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Pages (from-to) | 70 - 77 |
Number of pages | 8 |
Journal | Journal of Acquired Immune Deficiency Syndromes |
Volume | 53 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jan 2010 |
Bibliographical note
Other: PM:19531926Keywords
- Antiretroviral therapy
- CD4 lymphocyte count
- Cohort
- Highly active
- Low-income population
- Mortality
- Treatment outcome
- Viral load
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Dive into the research topics of 'Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings'. Together they form a unique fingerprint.Projects
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MONITORING AND MODELLING PROGNOSIS IN THE ERA OF HAART
Sterne, J. A. C. (Principal Investigator)
1/02/08 → 1/02/11
Project: Research