Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers
- 2 January 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 20 (1), 67-71
- https://doi.org/10.1097/01.aids.0000196178.73174.24
Abstract
Objectives: To describe the characteristics of deaths that occur among HIV-positive individuals in the HAART era. Design: Observational database. Methods: Deaths were reviewed that occurred among HIV-positive individuals seen at the Royal Free Hospital, London between January 1998 and December 2003. Results: Over the study period, there were 121 deaths; death rates declined from approximately 2.0/100 person-years of follow-up in 1998–2000 to approximately 1.0/100 person-years of follow-up in 2001–2003. Approximately one half of deaths (45.5%) were from AIDS-related causes and 74 deaths (61.2%) occurred in individuals who had received HAART: patients had been exposed to a median of seven (range 2–14) antiretroviral drugs and two-fifths had started treatment in the pre-HAART era. Another 15 patients had received only non-HAART treatment regimens prior to death. The median pre-death CD4 cell counts were 68 and 167 cells/μl among those who had and had not received HAART; 23 (31.1%) and 4 (8.5%) had HIV RNA < 400 copies/ml, respectively. Of the patients exposed to HAART for at least 6 months and who experienced viral rebound, information was available on resistance for 26 (21.5% of the total deaths) and 19 of those tested had at least one resistance mutation (median 5, range, 1–16). Conclusions: While mortality rates among HIV-infected individuals at our centre have fallen since 1988, the deaths that do now occur are more diverse and are the result of a number of factors, including late presentation, delayed uptake of HAART and the previous use of treatment combinations that are now viewed as suboptimal.Keywords
This publication has 11 references indexed in Scilit:
- Estimating HIV‐1 Drug Resistance in Antiretroviral‐Treated Individuals in the United KingdomThe Journal of Infectious Diseases, 2005
- Multiple drug class-wide resistance associated with poorer survival after treatment failure in a cohort of HIV-infected patientsAIDS, 2005
- Newly diagnosed HIV infections: review in UK and IrelandBMJ, 2005
- Late presenters in the era of highly active antiretroviral therapyAIDS, 2004
- Antiretroviral Resistance among HIV‐Infected Persons Who Have Died in British Columbia, in the Era of Modern Antiretroviral TherapyThe Journal of Infectious Diseases, 2004
- Relationship between drug resistance and HIV-1 disease progression or death in patients undergoing resistance testingAIDS, 2004
- Anemia and Survival in Human Immunodeficiency VirusClinical Infectious Diseases, 2003
- Current Management Challenges in HIV: Tolerability of Antiretrovirals and Metabolic ComplicationsAIDS Patient Care and STDs, 2003
- Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studiesThe Lancet, 2002
- Increasing Impact of Chronic Viral Hepatitis on Hospital Admissions and Mortality among HIV-Infected PatientsAIDS Research and Human Retroviruses, 2001