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Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers

Sabin, CA; Smith, CJ; Youle, M; Lampe, FC; Bell, DR; Puradiredja, D; Lipman, MCI; ... Johnson, MA; + view all (2006) Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers. AIDS , 20 (1) 67 - 71.

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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 214) 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/mu l 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. (C) 2006 Lippincott Williams & Wilkins.

Type: Article
Title: Deaths in the era of HAART: contribution of late presentation, treatment exposure, resistance and abnormal laboratory markers
Keywords: mortality, HAART, cause of death, genotypic resistance, abnormal laboratory measurements, ACTIVE ANTIRETROVIRAL THERAPY, HIV-INFECTED PATIENTS, DRUG-RESISTANCE, SURVIVAL
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/138474
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