PMID- 31852025 OWN - NLM STAT- MEDLINE DCOM- 20210928 LR - 20210928 IS - 1468-1293 (Electronic) IS - 1464-2662 (Print) IS - 1464-2662 (Linking) VI - 21 IP - 6 DP - 2020 Jul TI - Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific. PG - 397-402 LID - 10.1111/hiv.12836 [doi] AB - OBJECTIVES: Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia-Pacific. METHODS: PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/muL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow-up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow-up as a competing risk. RESULTS: A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first-year mortality rate was 4.27 per 100 person-years (PY). Thirty-eight deaths (52%) were AIDS-related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)-related, 13 (18%) were non-AIDS-related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub-hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60-5.32] compared to BMI 18.5-24.9, and alanine aminotransferase (ALT) >/= 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62-23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51-100 cells/muL: SHR 0.28; 95% CI 0.14-0.55; and > 100 cells/muL: SHR 0.12; 95% CI 0.05-0.26) was associated with reduced hazard for mortality compared to CD4 count 50 cell/muL are associated with improved short-term survival rates, even in those with late stages of HIV disease. CI - (c) 2019 British HIV Association. FAU - Rupasinghe, D AU - Rupasinghe D AUID- ORCID: 0000-0002-4014-3570 AD - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. FAU - Kiertiburanakul, S AU - Kiertiburanakul S AD - Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. FAU - Kamarulzaman, A AU - Kamarulzaman A AD - University Malaya Medical Centre, Kuala Lumpur, Malaysia. FAU - Zhang, F AU - Zhang F AD - Beijing Ditan Hospital, Capital Medical University, Beijing, China. FAU - Kumarasamy, N AU - Kumarasamy N AD - CART CRS, Voluntary Health Services, Chennai, India. FAU - Chaiwarith, R AU - Chaiwarith R AD - Research Institute for Health Sciences, Chiang Mai, Thailand. FAU - Merati, T P AU - Merati TP AD - Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia. FAU - Do, C D AU - Do CD AD - Bach Mai Hospital, Hanoi, Vietnam. FAU - Khusuwan, S AU - Khusuwan S AD - Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. FAU - Avihingsanon, A AU - Avihingsanon A AUID- ORCID: 0000-0003-3222-9611 AD - HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand. FAU - Lee, M P AU - Lee MP AD - Queen Elizabeth Hospital, Hong Kong SAR, China. FAU - Ly, P S AU - Ly PS AD - National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia. FAU - Yunihastuti, E AU - Yunihastuti E AD - Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. FAU - Nguyen, K V AU - Nguyen KV AD - National Hospital for Tropical Diseases, Hanoi, Vietnam. FAU - Ditangco, R AU - Ditangco R AD - Research Institute for Tropical Medicine, Muntinlupa City, Philippines. FAU - Chan, Y J AU - Chan YJ AD - Taipei Veterans General Hospital, Taipei, Taiwan. FAU - Pujari, S AU - Pujari S AD - Institute of Infectious Diseases, Pune, India. FAU - Ng, O T AU - Ng OT AD - Tan Tock Seng Hospital, Singapore City, Singapore. FAU - Choi, J Y AU - Choi JY AD - Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. FAU - Sim, Blh AU - Sim B AD - Hospital Sungai Buloh, Sungai Buloh, Malaysia. FAU - Tanuma, J AU - Tanuma J AD - National Center for Global Health and Medicine, Tokyo, Japan. FAU - Sangle, S AU - Sangle S AD - BJ Government Medical College and Sassoon General Hospitals, Pune, India. FAU - Ross, J AU - Ross J AD - TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand. FAU - Law, M AU - Law M AD - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. LA - eng GR - U01 AI069907/AI/NIAID NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20191218 PL - England TA - HIV Med JT - HIV medicine JID - 100897392 RN - 0 (Anti-HIV Agents) RN - EC 2.6.1.2 (Alanine Transaminase) SB - IM MH - Adult MH - Alanine Transaminase/metabolism MH - Anti-HIV Agents/*therapeutic use MH - CD4 Lymphocyte Count MH - Cause of Death MH - Female MH - HIV Infections/blood/*drug therapy/metabolism/*mortality MH - Humans MH - Male MH - Mortality MH - Poverty MH - Time-to-Treatment PMC - PMC7299786 MID - NIHMS1570286 OTO - NOTNLM OT - Asia-Pacific OT - HIV OT - advanced disease OT - mortality EDAT- 2019/12/19 06:00 MHDA- 2021/09/29 06:00 PMCR- 2021/07/01 CRDT- 2019/12/19 06:00 PHST- 2019/11/19 00:00 [accepted] PHST- 2019/12/19 06:00 [pubmed] PHST- 2021/09/29 06:00 [medline] PHST- 2019/12/19 06:00 [entrez] PHST- 2021/07/01 00:00 [pmc-release] AID - 10.1111/hiv.12836 [doi] PST - ppublish SO - HIV Med. 2020 Jul;21(6):397-402. doi: 10.1111/hiv.12836. Epub 2019 Dec 18.