title: Long-term antiretroviral treatment outcomes in seven countries in the Caribbean.
abstract: OBJECTIVE
  To report long-term HIV treatment outcomes in 7 Caribbean countries.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  We report outcomes for all antiretroviral therapy (ART) naive adult patients enrolled on ART from program inception until study closing for cohorts in Barbados, the Dominican Republic, Haiti, Jamaica, Martinique, Trinidad, and Puerto Rico. Incidence and predictors of mortality were analyzed by time-to-event approaches.
  
  
  RESULTS
  A total of 8203 patients were on ART from 1998 to 2008. Median follow-up time was 31 months (interquartile range: 14-50 months). The overall mortality was 13%: 6% in Martinique, 8% in Jamaica, 11% in Trinidad, 13% in Haiti, 15% in the Dominican Republic, 15% in Barbados, and 24% in Puerto Rico. Mortality was associated with male gender [hazard ratio (HR), 1.58; 95% confidence interval (CI): 1.33 to 1.87], body weight (HR, 0.85 per 10 pounds; 95% CI: 0.82 to 0.89), hemoglobin (HR, 0.84 per g/dL; 95% CI: 0.80 to 0.88), CD4 cell count (0.90 per 50 CD4 cells; 95% CI: 0.86 to 0.93), concurrent tuberculosis (HR, 1.58; 95% CI: 1.25 to 2.01) and age (HR, 1.19 per 10 years; 95% CI: 1.11 to 1.28). After controlling for these variables, mortality in Martinique, Jamaica, Trinidad, and Haiti was not significantly different. A total of 75% of patients remained alive and in care at the end of the study period.
  
  
  CONCLUSIONS
  Long-term mortality rates vary widely across the Caribbean countries. Much of the difference can be explained by disease severity at ART initiation, nutritional status, and concurrent tuberculosis. Earlier ART initiation will be critical to improve the outcomes.
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti. skoenig@partners.org)
authors.forename: Serena P
authors.initials: SP
authors.lastname: Koenig
authors.forename: Luis A
authors.initials: LA
authors.lastname: Rodriguez
authors.forename: Courtenay
authors.initials: C
authors.lastname: Bartholomew
authors.forename: Alison
authors.initials: A
authors.lastname: Edwards
authors.forename: Tracie E
authors.initials: TE
authors.lastname: Carmichael
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Barrow
authors.forename: André
authors.initials: A
authors.lastname: Cabié
authors.forename: Robert
authors.initials: R
authors.lastname: Hunter
authors.forename: Giselle
authors.initials: G
authors.lastname: Vasquez-Mora
authors.forename: Avion
authors.initials: A
authors.lastname: Quava-Jones
authors.forename: Nicholas
authors.initials: N
authors.lastname: Adomakoh
authors.forename: J
authors.initials: J
authors.lastname: Peter Figueroa
authors.forename: Bernard
authors.initials: B
authors.lastname: Liautaud
authors.forename: Magaly
authors.initials: M
authors.lastname: Torres
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D006454:Hemoglobins