title: Predictors of 5-year mortality in HIV-infected adults starting highly active antiretroviral therapy in Thailand.
abstract: OBJECTIVE
  To estimate the early and long-term mortalities and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand.
  
  
  METHODS
  A prospective observational cohort study.
  
  
  METHODS
  Previously untreated adults starting HAART in 2002-2009 were followed-up in 43 public hospitals. Kaplan-Meier probability of survival was estimated up to 5 years of therapy. Factors associated with early (≤6 months) and long-term (>6 months) mortalities were assessed using Cox regression analyses.
  
  
  RESULTS
  A total of 1578 adults received HAART (74% women; median age, 33 years; CD4 cell count, 124/mL), with a median follow-up of 50 months (interquartile range, 41-66). Eighty-nine patients (6%) died (37 occurred ≤6 months and 52 occurred >6 months) and 183 (12%) were lost to follow-up. Probability of survival [95% confidence interval (CI)] was 97.5% (96.7% to 98.2%) at 6 months, 96.6% (95.6% to 97.4%) at 1 year, and 93.5% (91.9% to 94.8%) at 5 years. Probability of being alive and on follow-up was 80.8% (78.5% to 82.8%) at 5 years. Early mortality was associated with anemia [adjusted hazard ratio (aHR) 3.6, 95% CI: 1.7 to 7.5] and low CD4 count (aHR 1.6, 95% CI: 1.1 to 2.2 per 50 cells decrease) at treatment initiation. Long-term mortality was associated with persistent anemia (aHR 4.9, 95% CI: 2.1 to 11.6), CD4 increase from baseline <50 cells per cubic millimeter (aHR 3.1, 95% CI: 1.6 to 5.7), and viral load >1000 copies per milliliter (aHR 2.8, 95% CI: 1.3 to 6.1) at 6 months of HAART; male gender; and calendar year of enrollment.
  
  
  CONCLUSIONS
  Early mortality was associated with anemia and severe immunosuppression at initiation of therapy. Long-term mortality was associated with persistent anemia, CD4 count increase, and virological response at 6 months of therapy over baseline characteristics, highlighting the importance of laboratory monitoring.
authors.affiliation: Program for HIV Prevention and Treatment (IRD UMI 174), Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. federica.fregonese@phpt.org
authors.forename: Federica
authors.initials: F
authors.lastname: Fregonese
authors.forename: Intira J
authors.initials: IJ
authors.lastname: Collins
authors.forename: Gonzague
authors.initials: G
authors.lastname: Jourdain
authors.forename: Sophie
authors.initials: S
authors.lastname: Lecoeur
authors.forename: Tim R
authors.initials: TR
authors.lastname: Cressey
authors.forename: Nicole
authors.initials: N
authors.lastname: Ngo-Giang-Houng
authors.forename: Sukit
authors.initials: S
authors.lastname: Banchongkit
authors.forename: Apichat
authors.initials: A
authors.lastname: Chutanunta
authors.forename: Malee
authors.initials: M
authors.lastname: Techapornroong
authors.forename: Marc
authors.initials: M
authors.lastname: Lallemant
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013785:Thailand; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents