@article{fdi:010057241,
  title = {{L}aboratory and clinical predictors of disease progression following initiation of combination therapy in {HIV}-infected adults in {T}hailand},
  author = {{D}uong, {T}. and {J}ourdain, {G}onzague and {N}go-{G}iang-{H}uong, {N}icole and {L}e {C}oeur, {S}ophie and {K}antipong, {P}. and {B}uranabanjasatean, {S}. and {L}eenasirimakul, {P}. and {A}riyadej, {S}. and {T}ansuphasawasdikul, {S}. and {T}hongpaen, {S}. and {L}allemant, {M}arc},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {D}ata on determinants of long-term disease progression in {HIV}-infected patients on antiretroviral therapy ({ART}) are limited in low and middle-income settings. {M}ethods: {E}ffects of current {CD}4 count, viral load and haemoglobin and diagnosis of {AIDS}-defining events ({ADE}s) after start of combination {ART} (c{ART}) on death and new {ADE}s were assessed using {P}oisson regression, in patient aged >= 18 years within a multi-centre cohort in {T}hailand. {R}esults: {A}mong 1,572 patients, median follow-up from c{ART} initiation was 4.4 ({IQR} 3.6-6.3) years. {T}he analysis of death was based on 60 events during 6,573 person-years; 30/50 (60%) deaths with underlying cause ascertained were attributable to infections. {A}nalysis of new {ADE} included 192 events during 5,865 person-years; {TB} and {P}neumocystis jiroveci pneumonia were the most commonly presented first new {ADE} (35% and 20% of cases, respectively). {I}n multivariable analyses, low current {CD}4 count after starting c{ART} was the strongest predictor of death and of new {ADE}. {E}ven at {CD}4 above 200 cells/mm 3, survival improved steadily with {CD}4, with mortality rare at >= 500 cells/mm 3 (rate 1.1 per 1,000 person-years). {H}aemoglobin had a strong independent effect, while viral load was weakly predictive with poorer prognosis only observed at >= 100,000 copies/ml. {M}ortality risk increased following diagnosis of {ADE}s during c{ART}. {T}he decline in mortality rate with duration on c{ART} (from 21.3 per 1,000 person-years within first 6 months to 4.7 per 1,000 person-years at >= 36 months) was accounted for by current {CD}4 count. {C}onclusions: {P}atients with low {CD}4 count or haemoglobin require more intensive diagnostic and treatment of underlying causes. {M}aintaining {CD}4 >= 500 cells/mm(3) minimizes mortality. {H}owever, patient monitoring could potentially be relaxed at high {CD}4 count if resources are limited. {O}ptimal {ART} monitoring strategies in low-income settings remain a research priority. {B}etter understanding of the aetiology of anaemia in patients on {ART} could guide prevention and treatment.},
  keywords = {},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {7},
  numero = {8},
  pages = {e43375},
  ISSN = {1932-6203},
  year = {2012},
  DOI = {10.1371/journal.pone.0043375},
  URL = {https://www.documentation.ird.fr/hor/fdi:010057241},
}