Predictors of mortality among HIV–infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

Bhowmik, Arijit; Bhandari, Subhasis; De, Rajyasree; Guha, Subhasish Kamal

doi:10.1016/s1995-7645(12)60187-4

Cited by 22 publications

(26 citation statements)

References 19 publications

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“…Serum albumin has also been inversely associated with IL-6 levels, a proinflammatory cytokine, which has been shown to upregulate HIV replication (Ward et al 1999). Adult ART-naive patients with low baseline serum albumin had an eight times increased risk of death than those with higher serum albumin levels, and patients with CD4 count of less than 100 cells were two times at higher risk of death compared to those with higher CD4 counts (Bhowmik et al 2012). Mild anemia was found to be common in ARV-naïve Thai and Cambodian children without advanced HIV.…”

Section: Discussionmentioning

confidence: 90%

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

et al. 2015

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A range of factors contributes to white matter damage in vertically infected HIV-positive children. These may include combination antiretroviral treatment (cART) regimen, sociodemographic factors, nutritional-hematological status, HIV-relevant clinical variables, and cognitive functioning. We explored associations between a number of these factors and diffusion tensor imaging (DTI) measures in 50 cART-treated children aged 6 to 15 years. Fractional anisotropy (FA), mean diffusion (MD), radial diffusion (RD), and axial diffusion (AD) were derived from 48 cerebral white matter regions. Significant associations between a number of the clinical variables and white matter integrity were found. Decreased FA, a measure of neuronal damage, was associated with being on second-line cART, low hemoglobin, and younger age. Children with increased MD, a measure of neuronal damage, were younger, had reduced albumin and hemoglobin, and increased viral load. Decreased AD, a measure of axonal damage, was associated with increased viral load and total protein, decreased albumin and hemoglobin, younger age, poorer fronto-striatal cognition, and being on second-line cART. Increased RD, a measure of myelin loss, was associated with younger age, low current CD4 count, low albumin and hemoglobin, and higher viral load and total protein. The current findings underline the possible association of first-line treatment failure with white matter brain dysfunction in pediatric neuroHIV and the importance of examining the effects of HIV disease in the context of treatable clinical variables such as anemia and nutritional status.

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Section: Discussionmentioning

confidence: 90%

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

et al. 2015

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“…Hypoalbuminemia, present in diverse chronic inflammatory states and a known risk factor for HIV disease progression and mortality as well as post-ART TB in resource-limited settings, had the strongest independent association with TB risk in our multinational population. [3,42] Until now, however, only very limited data have been available for CRP, IP-10, or LPS. One previous study (at a single center in Uganda) found that adults with pre-ART CRP >5 mg/L were at increased risk of ART-associated TB within of the first year of treatment, but only eight TB cases were identified during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein (CRP), Interferon Gamma-Inducible Protein 10 (IP-10), and Lipopolysaccharide (LPS) Are Associated with Risk of Tuberculosis after Initiation of Antiretroviral Therapy in Resource-Limited Settings

et al. 2015

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ObjectiveThe association between pre-antiretroviral (ART) inflammation and immune activation and risk for incident tuberculosis (TB) after ART initiation among adults is uncertain.DesignNested case-control study (n = 332) within ACTG PEARLS trial of three ART regimens among 1571 HIV-infected, treatment-naïve adults in 9 countries. We compared cases (participants with incident TB diagnosed by 96 weeks) to a random sample of controls (participants who did not develop TB, stratified by country and treatment arm).MethodsWe measured pre-ART C-reactive protein (CRP), EndoCab IgM, ferritin, interferon gamma (IFN-γ), interleukin 6 (IL-6), interferon gamma-inducible protein 10 (IP-10), lipopolysaccharide (LPS), soluble CD14 (sCD14), tumor necrosis factor alpha (TNF-α), and CD4/DR+/38+ and CD8/DR+/38+ T cells. Markers were defined according to established cutoff definitions when available, 75th percentile of measured values when not, and detectable versus undetectable for LPS. Using logistic regression, we measured associations between biomarkers and incident TB, adjusting for age, sex, study site, treatment arm, baseline CD4 and log10 viral load. We assessed the discriminatory value of biomarkers using receiver operating characteristic (ROC) analysis.ResultsSeventy-seven persons (4.9%) developed incident TB during follow-up. Elevated baseline CRP (aOR 3.25, 95% CI: 1.55–6.81) and IP-10 (aOR 1.89, 95% CI: 1.05–3.39), detectable plasma LPS (aOR 2.39, 95% CI: 1.13–5.06), and the established TB risk factors anemia and hypoalbuminemia were independently associated with incident TB. In ROC analysis, CRP, albumin, and LPS improved discrimination only modestly for TB risk when added to baseline routine patient characteristics including CD4 count, body mass index, and prior TB.ConclusionIncident TB occurs commonly after ART initiation. Although associated with higher post-ART TB risk, baseline CRP, IP-10, and LPS add limited value to routine patient characteristics in discriminating who develops active TB. Besides determining ideal cutoffs for these biomarkers, additional biomarkers should be sought that predict TB disease in ART initiators.

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“…In addition, tuberculosis was found to be the most important cause of death and it caused 48% of the total death and other studies also showed greater estimate than this current findings [15,[18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 41%

“…When ART is initiated at advanced stage of immune suppression denoted by low serum albumin level and CD4 cell count, risk of mortality is increased. This highlights the importance of timely initiation of ART drugs, namely, early detection of HIV infection and early managements of opportunistic infection including tuberculosis in the resource limited countries [15]. Similarly, the current study aimed to supplement the available evidences of mortality of patients on ART program in Ethiopia.…”

Section: Introductionmentioning

confidence: 97%

Mortality predictors of HIV-infected patients on antiretroviral therapy in Debre Tabor General Hospital and Woreta Health Center, South Gondar Zone, Northwest Ethiopia

Assefa¹,

Ebrahim²

2017

Asian Pac J Trop Dis

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Predictors of mortality among HIV–infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

Cited by 22 publications

References 19 publications

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

C-Reactive Protein (CRP), Interferon Gamma-Inducible Protein 10 (IP-10), and Lipopolysaccharide (LPS) Are Associated with Risk of Tuberculosis after Initiation of Antiretroviral Therapy in Resource-Limited Settings

Mortality predictors of HIV-infected patients on antiretroviral therapy in Debre Tabor General Hospital and Woreta Health Center, South Gondar Zone, Northwest Ethiopia

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