title: Clinical, demographic and laboratory parameters at HAART initiation associated with decreased post-HAART survival in a U.S. military prospective HIV cohort.
abstract: BACKGROUND
  Although highly active antiretroviral therapy (HAART) has improved HIV survival, some patients receiving therapy are still dying. This analysis was conducted to identify factors associated with increased risk of post-HAART mortality.
  
  
  METHODS
  We evaluated baseline (prior to HAART initiation) clinical, demographic and laboratory factors (including CD4+ count and HIV RNA level) for associations with subsequent mortality in 1,600 patients who began HAART in a prospective observational cohort of HIV-infected U.S. military personnel.
  
  
  RESULTS
  Cumulative mortality was 5%, 10% and 18% at 4, 8 and 12 years post-HAART. Mortality was highest (6.23 deaths/100 person-years [PY]) in those with ≤ 50 CD4+ cells/mm3 before HAART initiation, and became progressively lower as CD4+ counts increased (0.70/100 PY with ≥ 500 CD4+ cells/mm3). In multivariate analysis, factors significantly (p < 0.05) associated with post-HAART mortality included: increasing age among those ≥ 40 years (Hazard ratio [HR] = 1.32 per 5 year increase), clinical AIDS events before HAART (HR = 1.93), ≤ 50 CD4+ cells/mm3 (vs. CD4+ ≥ 500, HR = 2.97), greater HIV RNA level (HR = 1.36 per one log10 increase), hepatitis C antibody or chronic hepatitis B (HR = 1.96), and HIV diagnosis before 1996 (HR = 2.44). Baseline CD4+ = 51-200 cells (HR = 1.74, p = 0.06), and hemoglobin < 12 gm/dL for women or < 13.5 for men (HR = 1.36, p = 0.07) were borderline significant.
  
  
  CONCLUSIONS
  Although treatment has improved HIV survival, defining those at greatest risk for death after HAART initiation, including demographic, clinical and laboratory correlates of poorer prognoses, can help identify a subset of patients for whom more intensive monitoring, counseling, and care interventions may improve clinical outcomes and post-HAART survival.
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. lifso001@umn.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Lifson
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Krantz
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Grambsch
authors.forename: Grace E
authors.initials: GE
authors.lastname: Macalino
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.forename: Jason F
authors.initials: JF
authors.lastname: Okulicz
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: John H
authors.initials: JH
authors.lastname: Powers
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan