Somnuek Sungkanuparph1, Taywin Chakriyanuyok, Bodin Butthum. 1. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok 10400, Thailand. rasuy@mahidol.ac.th
Abstract
OBJECTIVES: To determine the impact of antiretroviral therapy (ART) on the long-term survival of AIDS patients with CMV disease and evaluate long-term outcomes of ART. METHODS: A retrospective cohort study was conducted among HIV-infected patients with CMV disease in a medical school hospital during 1996-2005 and followed-up until June 2007. RESULTS: There were 154 patients, mean age 34.5 years and 57.8% were male. Organ involvement of CMV disease included retina (94.8%), central nervous system, lungs, and gastrointestinal tract. Median CD4 cell count was 20 cells/mm(3) and 99 patients received ART. During median follow-up of 32 months (interquartile range 23-96), 29.2% of patients died. From Kaplan-Meier analysis, median survival is significantly longer in patients receiving ART (>116.2 vs. 21.6 months, log-rank test, p<0.001). From Cox's proportional hazard model, ART (HR 0.6, p<0.001) and previous opportunistic infections (HR 3.5, p=0.025) were negatively and positively associated with death, respectively. At median time of 69 months (interquartile range 34-101) in patients who received ART, 80.8% had HIV-1 RNA <50 copies/mL and median CD4 was 421 cells/mm(3). One patient had immune reconstitution syndrome at 3 months after initiation of ART and resulted in permanent vision loss. CONCLUSIONS: ART significantly improves long-term survival of AIDS patients with CMV disease. Long-term virological and immunological outcomes are durable.
OBJECTIVES: To determine the impact of antiretroviral therapy (ART) on the long-term survival of AIDSpatients with CMV disease and evaluate long-term outcomes of ART. METHODS: A retrospective cohort study was conducted among HIV-infectedpatients with CMV disease in a medical school hospital during 1996-2005 and followed-up until June 2007. RESULTS: There were 154 patients, mean age 34.5 years and 57.8% were male. Organ involvement of CMV disease included retina (94.8%), central nervous system, lungs, and gastrointestinal tract. Median CD4 cell count was 20 cells/mm(3) and 99 patients received ART. During median follow-up of 32 months (interquartile range 23-96), 29.2% of patients died. From Kaplan-Meier analysis, median survival is significantly longer in patients receiving ART (>116.2 vs. 21.6 months, log-rank test, p<0.001). From Cox's proportional hazard model, ART (HR 0.6, p<0.001) and previous opportunistic infections (HR 3.5, p=0.025) were negatively and positively associated with death, respectively. At median time of 69 months (interquartile range 34-101) in patients who received ART, 80.8% had HIV-1 RNA <50 copies/mL and median CD4 was 421 cells/mm(3). One patient had immune reconstitution syndrome at 3 months after initiation of ART and resulted in permanent vision loss. CONCLUSIONS: ART significantly improves long-term survival of AIDSpatients with CMV disease. Long-term virological and immunological outcomes are durable.
Authors: Somnuek Sungkanuparph; Rebecca Oyomopito; Sunee Sirivichayakul; Thira Sirisanthana; Patrick C K Li; Pacharee Kantipong; Christopher K C Lee; Adeeba Kamarulzaman; Liesl Messerschmidt; Matthew G Law; Praphan Phanuphak Journal: Clin Infect Dis Date: 2011-04-15 Impact factor: 9.079