TY - JOUR
T1 - Risk factors for mortality in patients with AIDS in the era of highly active antiretroviral therapy
AU - Jabs, Douglas A.
AU - Holbrook, Janet T.
AU - Van Natta, Mark L.
AU - Clark, Rebecca
AU - Jacobson, Mark A.
AU - Kempen, John H.
AU - Murphy, Robert Leo
N1 - Funding Information:
Supported by cooperative agreements from the National Eye Institute, National Institutes of Health, Bethesda, Maryland, to The Johns Hopkins University School of Medicine (no.: U10 EY08052), The Johns Hopkins University Bloomberg School of Public Health (no.: U10 EY08057), and the University of Wisconsin, Madison (no.: U10 EY08067). Additional support was provided by the National Center for Research Resources, National Institutes of Health, Bethesda, Maryland, through the General Clinical Research Center (grant nos.: 5MO1 RR00188 [Baylor College of Medicine], MO1 RR00052 [Johns Hopkins University School of Medicine], 5MO1 RR05096 [Louisiana State University], 5MO1 RR00865 [University of California, Los Angeles], 5MO1 RR05280 [University of Miami], 5M01 RR00046 [University of North Carolina], 5MO1 RR00043 [University of Southern California], 5MO1 RR00047 [Weill Medical College of Cornell University]). Dr Jabs is the recipient of a Research to Prevent Blindness (New York, New York) Senior Scientific Investigator Award.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/5/1
Y1 - 2005/5/1
N2 - Objective: To evaluate risk factors for mortality among patients with AIDS in the era of highly active antiretroviral therapy (HAART), particularly the effect of cytomegalovirus (CMV). Design: Prospective cohort study of patients with AIDS, conducted from 1998 through 2003. Participants: One thousand five hundred eighty-three patients with AIDS, of whom 374 had CMV retinitis. Methods: Patients were contacted every 3 months, with examinations at least every 6 months, in which standardized data were collected on AIDS history and treatment, eye examinations, and hematologic, virologic, and immunologic laboratory data. Main Outcome Measure: Mortality. Results: The overall mortality rate was 0.07 deaths/person-year. In a multivariate analysis, the following baseline risk factors were associated with an increased mortality: higher human immunodeficiency virus (HIV) viral load (relative risk [RR] = 4.6 for HIV viral load >100 000 copies/ml vs. <400 copies/ml; P<0.0001), lower CD4+ T-cell count at enrollment (RR = 3.8 for CD4+ T cell count 0-49 cells/μl vs. ≥200 cells/μl; P<0.0001), CMV viral load ≥400 copies/ml (RR = 1.9; P = 0.002), lower hemoglobin (RR = 1.7 for hemoglobin <10 g/dl; P = 0.009), a history of cryptococcal meningitis (RR = 1.7; P = 0.02), CMV retinitis (RR = 1.6; P = 0.0002), and Karnofsky score ≤80 (RR = 1.4; P = 0.008). Conclusions: In the era of HAART, CMV disease as manifested by CMV retinitis and a detectable CMV viral load were associated with an increased risk for mortality, even after adjusting for demographic, treatment, immunologic, and HIV virologic factors.
AB - Objective: To evaluate risk factors for mortality among patients with AIDS in the era of highly active antiretroviral therapy (HAART), particularly the effect of cytomegalovirus (CMV). Design: Prospective cohort study of patients with AIDS, conducted from 1998 through 2003. Participants: One thousand five hundred eighty-three patients with AIDS, of whom 374 had CMV retinitis. Methods: Patients were contacted every 3 months, with examinations at least every 6 months, in which standardized data were collected on AIDS history and treatment, eye examinations, and hematologic, virologic, and immunologic laboratory data. Main Outcome Measure: Mortality. Results: The overall mortality rate was 0.07 deaths/person-year. In a multivariate analysis, the following baseline risk factors were associated with an increased mortality: higher human immunodeficiency virus (HIV) viral load (relative risk [RR] = 4.6 for HIV viral load >100 000 copies/ml vs. <400 copies/ml; P<0.0001), lower CD4+ T-cell count at enrollment (RR = 3.8 for CD4+ T cell count 0-49 cells/μl vs. ≥200 cells/μl; P<0.0001), CMV viral load ≥400 copies/ml (RR = 1.9; P = 0.002), lower hemoglobin (RR = 1.7 for hemoglobin <10 g/dl; P = 0.009), a history of cryptococcal meningitis (RR = 1.7; P = 0.02), CMV retinitis (RR = 1.6; P = 0.0002), and Karnofsky score ≤80 (RR = 1.4; P = 0.008). Conclusions: In the era of HAART, CMV disease as manifested by CMV retinitis and a detectable CMV viral load were associated with an increased risk for mortality, even after adjusting for demographic, treatment, immunologic, and HIV virologic factors.
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U2 - 10.1016/j.ophtha.2004.10.049
DO - 10.1016/j.ophtha.2004.10.049
M3 - Article
C2 - 15878056
AN - SCOPUS:18244378223
SN - 0161-6420
VL - 112
SP - 771
EP - 779
JO - Ophthalmology
JF - Ophthalmology
IS - 5
ER -
