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THE CAUSES OF UNFAVORABLE OUTCOMES AMONG PATIENTS TAKING HAART. Part 1

https://doi.org/10.22328/2077-9828-2015-7-3-48-55

Abstract

The present retrospective study of the causes of death among HIV patients taking HAART in 2010-2013 and of the significant factors of the lethal outcomes is based on a digital database comprising case histories of 647 patients including men (72,3%) and women (27,7%). The causes of death were categorized according ICD-10. The profiles of the causes of death and survival were determined. Odds ratios were calculated using fourfold contingency tables. Kaplan-Meyer curves were built to determine patients’ survival time (months). Results. Tentative infection routes are: parenteral, associated with intravenous drug use (IDU, 73%), heterosexual (17%) and homosexual (MSM, 1%). Among IDUs, death rate is 3,1 times higher in men than in women. IDUs discontinued therapy twice as often as patients who contracted HIV by the heterosexual route. In those who discontinued HAART the risk of death attributed to HIV is by 33% higher than in those who adhered to therapy. The total annual death rate in the period under study was 2,5% to 3,0%. Among those who started therapy in 2010-2013, 83% died in the first two years of treatment. The meant age at death was 36,5 years in men (95% CI: 35,8 to 37,2 years) and 34.8 years in women (95% CI: 33,7 to 35,9 years). The main cause of death in 72,0% of cases (n=466) was progression of HIV infection to AIDS. TB was found in 49% of these cases. Other causes included cardiovascular diseases (7,4%), liver pathology unrelated to HIV (5,4%), external causes (6,3%) including social circumstances, cancer unrelated to HIV (4%), other somatic conditions (2,8%), and iatrogenic causes (0,5%). No data were available in 4%. An association between CD4 cell counts at the onset of HAART and the causes of death was found. At baseline CD4 cell counts above 200 μL-1, causes unrelated to HIV predominated. At baseline CD4 cell counts <200 μL-1, patients died of HIV 2,31 times more often than at ≥200 μL-1. AIDS as the cause of death was regularly associated with low CD4 cell counts (<50 μL-1). No association between the causes of death and the times of survival was found (p>0,005) among patients treated with HAART. The mean time of survival after HIV diagnosis was 8,3 years.

About the Authors

N. G. Zakharova
Saint-Petersburg Center for Control of AIDS and Infectious Diseases
Russian Federation


S. I. Dvorak
Saint-Petersburg Center for Control of AIDS and Infectious Diseases
Russian Federation


S. L. Plavinski
North-Western State Medical University named after I.I. Mechnikov
Russian Federation


S. E. Toropov
Saint-Petersburg Center for Control of AIDS and Infectious Diseases
Russian Federation


V. V. Rassokhin
Saint-Petersburg Center for Control of AIDS and Infectious Diseases; First Pavlov State Medical University of Saint-Petersburg; Institute of Experimental Medicine
Russian Federation


N. A. Belyakov
Saint-Petersburg Center for Control of AIDS and Infectious Diseases; First Pavlov State Medical University of Saint-Petersburg; Institute of Experimental Medicine
Russian Federation


References

1. Hogg R., Lima V., Grabar S., Bonarek M. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14cohort studies // Lancet. - 2008. - Vol. 372. - Р. 293-299.

2. Mocroft A., Brettle R., Kirk O. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study // AIDS. - 2002. - Vol. 16. - Р. 1663-1671.

3. Obel N., Omland L.H., Kronborg G., Larsen C.S., Pedersen C., Pedersen G., Serensen H.T., Gerstoft J. Impact of Non-HIV and HIV Risk Factors on Survival in HIV-Infected Patients on HAART: A Population-Based Nationwide Cohort Study // PLoS One. - 2011. - Vol. 6 (7). - Р. 22698. Published online 2011 July 25. doi: 10.1371/journal.pone.0022698.

4. Рriis-Мuller N., Sabin C.A., Morfeldt L. Combination Antiretroviral Therapy and the Risk of Myocardial Infarction. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group // N. Engl. J. Med. - 2003. - Vol. 349. - Р. 1993-2003, DOI: 10.1056/NEJMoa030218.

5. Coopman S.A., Johnson R.A., Platt R., Stern R.S. Cutaneous disease and drug reactions in HIV infection // N. Engl. J. Med. - 1993. - Vol. 328. - P. 1670-1674.

6. Knight L., Muloiwa R., Dlamini S., Lehloenya R.J. Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis // PLoS One. - 2014.- DOI: 10.1371/journal.pone.0093543.

7. Lazovski J., Belloso W.H., Losso M.H., Benetucci J.A., Aquilia S., Bittar V., Bogdanowicz E.P., Cahn P.E., Casiró A.D., Cassetti I., Contarelli J.M., Corral J.A., Crinejo A., Daciuk L., David D.O., Guaragna G., Rakhmanova A., Vinogradova E., Yakovlev A., Zakharova N. Inferior Clinical Outcome of the CD4+ Cell Count-Guided Antiretroviral Treatment Interruption Strategy in the SMART Study: Role of CD4 + Cell Counts and HIV RNA Levels during Follow-up, // J. Inf. Diseases. - 2008. - Vol. 197 (8). - P. 1145-1155

8. Mocroft A., Brettle R., Kirk O., Blaxhult A., Parkin J.M., Antunes F. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study // AIDS. - 2002. - Vol. 16. - Р. 1663-1671.

9. Kuller L.H., Tracy R., Belloso W. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection // PLoS Med. - 2008. - Р. 203.

10. Weis N., Lindhardt B.Ø., Kronborg G., Hansen А-Brit E., Laursen A.L., Christensen P.B., Nielsen H., Møller A., Sørensen H.T., Obel N. Impact of Hepatitis C Virus Coinfection on Response to Highly Active Antiretroviral Therapy and Outcome in HIV-Infected Individuals: A Nationwide Cohort Study // Clin. Infect. Dis. - 2006. - Vol. 42 (10). - Р. 1481-1487.

11. Larsen M.V., Omland L.H., Gerstoft J., Røge B.T., Larsen C.S., Pedersen G., Obel N., Kronborg G. Impact of injecting drug use on response to highly active antiretroviral treatment in HIV-1-infected patients: A nationwide population-based cohort study // Scandinavian Journal of Infectious Diseases. - 2010. - Vol. 42 (11-12). - P. 917-923.

12. Gill J., May M., Saag M., Reiss P., Harris R., Justice A., Casabona J., Khaykin P., Vehreschild J. The Antiretroviral Therapy Cohort Collaboration Study Group. Causes of Death in HIV-1-Infected Patients Treated with Antiretroviral Therapy, 1996-2006: Collaborative Analysis of 13 HIV Cohort Studies // Clin. Infect. Dis. - 2010. - Vol. 50 (10). - Р. 1387-1396.

13. Справка «ВИЧ-инфекция в Российской Федерации на 31 декабря 2014 г. / Федеральный научно-методический Центр по профилактике и борьбе со СПИДом. - 4 с. - URL: http://www.hivrussia.ru/doc/docs.shtml. (дата обращения 20.03.2015 г.).

14. Ермак Т.Н., Кравченко А.В., Шахгильдян В.И., Канестри В.Г., Ладная Н.Н., Юрин О.Г. Анализ причин летальных исходов больных ВИЧ-инфекцией в Российской Федерации // Эпидемиология и инфекционные болезни. - М., 2010. - № 3. - С. 19-22

15. Пантелеева О.В., Тихонова Е.М., Косенко Ю.Ю., Дельнова Н.А., Гаврилова С.П., Бембеева Н.А. Эпидемиологическая характеристика летальных исходов ВИЧ-инфекции в Санкт-Петербурге в 2013 году // ВИЧ-инфекция и иммуносупрессии. - 2014. - Т.6, №4. - С. 112-113

16. Степанова Е.В., Леонова О.Н., Пантелеева О.В. Причины тяжелого течения и смертей у больных с ВИЧикоинфекцией // ВИЧ-инфекция и иммуносупрессии. - 2014. - Т. 6, № 4. - С. 115-116

17. Леонова О.Н., Рассохин В.В., Рахманова А.Г. Анализ летальных исходов у больных с ВИЧ-инфекцией по материалам отделения паллиативной медицины.// ВИЧ-инфекция и иммуносупрессии. - 2009. - Т. 1, № 2. - С. 63-68

18. Рахманова А.Г., Дмитриева М.И., Бубочкин А.Б. Причины смерти от ВИЧ-инфекции в 2012-2014 гг., кандидоз, как отягощающий фактор // ВИЧ-инфекция и иммуносупрессии. - 2014. - Т. 6, № 4. - С. 114

19. Яковлев А.А., Мусатов В.Б., Савченко М.А. Причины летальных исходов у ВИЧ-инфицированных пациентов, получающих антиретровирусную терапию // ВИЧ-инфекция и иммуносупрессии. - 2015. - Т. 7, № 1. - С. 84-89

20. Aschengrau A., George R. Essentials of Epidemiology in Public Health. - USA, 2008. - 516 р.

21. Плавинский С.Л. Биостатистика: Планирование, обработка и представление результатов биомедицинских исследований при помощи системы SAS.- СПб.: Издательский дом СПбМАПО, 2005. - 560 с.


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For citations:


Zakharova N.G., Dvorak S.I., Plavinski S.L., Toropov S.E., Rassokhin V.V., Belyakov N.A. THE CAUSES OF UNFAVORABLE OUTCOMES AMONG PATIENTS TAKING HAART. Part 1. HIV Infection and Immunosuppressive Disorders. 2015;7(3):48-55. (In Russ.) https://doi.org/10.22328/2077-9828-2015-7-3-48-55

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