title: Clinical and immunologic predictors of death after an acute opportunistic infection: results from ACTG A5164.
abstract: BACKGROUND
  In the pre-antiretroviral therapy (ART) era, markers of increased disease severity during an acute opportunistic infection (OI) were associated with mortality. Even with ART, mortality remains high during the first year after an OI in persons with advanced HIV infection, but it is unclear whether previous predictors of mortality remain valid in the current era.
  
  
  OBJECTIVE
  To determine clinical and immunological predictors of death after an OI.
  
  
  METHODS
  We used clinical data and stored plasma from ACTG A5164, a multicenter study evaluating the optimal timing of ART during a nontuberculous OI. We developed Cox models evaluating associations between clinical parameters and plasma marker levels at entry and time to death over the first 48 weeks after the diagnosis of OI. We developed multivariable models incorporating only clinical parameters, only plasma marker levels, or both.
  
  
  RESULTS
  The median CD4+ T-cell count in study participants at baseline was 29 cells/µL. Sixty-four percent of subjects had Pneumocystis jirovecii pneumonia (PCP). Twenty-three of 282 (8.2%) subjects died. In univariate analyses, entry mycobacterial infection, OI number, hospitalization, low albumin, low hemoglobin, lower CD4, and higher IL-8 and sTNFrII levels and lower IL-17 levels were associated with mortality. In the combined model using both clinical and immunologic parameters, the presence of an entry mycobacterial infection and higher sTNFrII levels were significantly associated with death.
  
  
  CONCLUSIONS
  In the ART era, clinical risk factors for death previously identified in the pre-ART era remain predictive. Additionally, activation of the innate immune system is associated with an increased risk of death following an acute OI.
authors.affiliation: Stanford University, Stanford, California.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Grant
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Komarow
authors.affiliation: Keck School of Medicine, Los Angeles, California.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Keck School of Medicine, Los Angeles, California.
authors.forename: Fred R
authors.initials: FR
authors.lastname: Sattler
authors.affiliation: University of California, Davis, Sacramento, California.
authors.forename: David M
authors.initials: DM
authors.lastname: Asmuth
authors.affiliation: University of California, Davis, Sacramento, California.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Pollard
authors.affiliation: Stanford University, Stanford, California.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zolopa
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000401:mortality*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: HIV infections/complications; mortality; opportunistic infections