Abstract
Abstract: :
Purpose: To evaluate the influence of CMV retinitis and demographic, medical, immunologic, and virologic factors on mortality in the era of highly active antiretroviral therapy (HAART). Methods:Data from 1,458 patients with AIDS enrolled in an ongoing prospective, multicenter, cohort study conducted from 1998 through 2003 were analyzed for risk factors for mortality, including demographic, medical, immunologic, and virologic factors. Results:There were 240 deaths. The overall mortality rate was 0.07 deaths/person–year. In a multiple regression analysis of baseline risk factors for mortality, CMV retinitis (relative risk [RR] = 1.8, P<0.0001), a history of cryptococcal meningitis (RR = 1.8, P=0.02), lower CD4+ T cell count at enrollment (RR = 3.9 for CD4+ T cell count 0–49 x 106 cells/L vs ≥200 x 106cells/L, P<0.0001), higher HIV viral load (RR = 4.7 for HIV viral load >100,000 copies/mL vs <400 copies/mL, P<0.0001), detectable CMV viral load (RR=1.8.0, P=0.006), and lower Karnofsky score at enrollment (RR=2.0 for score ≤70 vs 100, P=0.008) were associated with increased mortality. Other opportunistic infections were not associated with an increased risk of mortality. Although HAART was associated with a decreased risk of mortality in the univariate analysis (RR = 0.4, P<0.001), it was not associated in the multivariate analysis, as its effects were mediated through CD4+ T cell count and HIV viral load. Conclusions:In the era of HAART, CMV disease, as manifested by CMV retinitis, and detectable CMV viral load were associated with an increased risk for mortality, even after adjusting for demographic, immunologic, HIV virologic, and treatment factors.
Keywords: clinical (human) or epidemiologic studies: risk factor assessment • AIDS/HIV • cytomegalovirus