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Mortality and loss to follow-up among HIV-infected persons on long-term antiretroviral therapy in Latin America and the Caribbean

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dc.contributor.author Carriquiry, G.
dc.contributor.author Fink, V.
dc.contributor.author Koethe, J.R.
dc.contributor.author Giganti, M.J.
dc.contributor.author Jayathilake, K.
dc.contributor.author Blevins, M.
dc.contributor.author Cahn, P.
dc.contributor.author Grinsztejn, B.
dc.contributor.author Wolff, M.
dc.contributor.author Pape, J.W.
dc.contributor.author Padgett, D.
dc.contributor.author Sierra Madero, J.
dc.contributor.author Gotuzzo Herencia, José Eduardo
dc.contributor.author McGowan, C.C.
dc.contributor.author Shepherd, B.E.
dc.date.accessioned 2019-04-24T18:23:55Z
dc.date.available 2019-04-24T18:23:55Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/6480
dc.description.abstract Introduction: Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow-up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet). Methods: We assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART-nai¨ve adults (≥ 18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan-Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre-ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen. Results: A total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.6-6.2). The median age at ART initiation was 36 years (IQR: 30-44), subjects were predominantly male (63%), median CD4 count was 156 cells/μL (IQR: 60-251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non-nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.5-18.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five-year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR) = 1.65 (95% CI 1.47-1.87); p < 0.001), lower baseline CD4 (HR = 1.95 (95% CI 1.63-2.32) for 50 vs. 350 cells/μL; p < 0.001) and older age (HR = 1.47 (95% CI 1.29-1.69) for 50 vs. 30 years at ART initiation; p < 0.001). Conclusions: In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries Journal of the International AIDS Society
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject antiretrovirus agent en_US
dc.subject nonnucleoside reverse transcriptase inhibitor en_US
dc.subject acquired immune deficiency syndrome en_US
dc.subject adult en_US
dc.subject Article en_US
dc.subject Caribbean en_US
dc.subject CD4 lymphocyte count en_US
dc.subject controlled study en_US
dc.subject female en_US
dc.subject follow up en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject human en_US
dc.subject human cell en_US
dc.subject Human immunodeficiency virus infected patient en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject incidence en_US
dc.subject long term care en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject mortality en_US
dc.subject priority journal en_US
dc.subject risk factor en_US
dc.subject South and Central America en_US
dc.subject HIV Infections en_US
dc.subject immunology en_US
dc.subject middle aged en_US
dc.subject proportional hazards model en_US
dc.subject Adult en_US
dc.subject Antiretroviral Therapy, Highly Active en_US
dc.subject Caribbean Region en_US
dc.subject CD4 Lymphocyte Count en_US
dc.subject Female en_US
dc.subject Follow-Up Studies en_US
dc.subject HIV Infections en_US
dc.subject Humans en_US
dc.subject Latin America en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Proportional Hazards Models en_US
dc.title Mortality and loss to follow-up among HIV-infected persons on long-term antiretroviral therapy in Latin America and the Caribbean en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7448/IAS.18.1.20016
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1758-2652

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