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dc.contributor.authorTrinh Duongen_US
dc.contributor.authorGonzague Jourdainen_US
dc.contributor.authorNicole Ngo-Giang-Huongen_US
dc.contributor.authorSophie Le Cœuren_US
dc.contributor.authorPacharee Kantipongen_US
dc.contributor.authorSudanee Buranabanjasateanen_US
dc.contributor.authorPrattana Leenasirimakulen_US
dc.contributor.authorSriprapar Ariyadejen_US
dc.contributor.authorSomboon Tansuphasawasdikulen_US
dc.contributor.authorSuchart Thongpaenen_US
dc.contributor.authorMarc Lallemanten_US
dc.date.accessioned2018-09-04T05:59:33Z-
dc.date.available2018-09-04T05:59:33Z-
dc.date.issued2012-08-15en_US
dc.identifier.issn19326203en_US
dc.identifier.other2-s2.0-84865054223en_US
dc.identifier.other10.1371/journal.pone.0043375en_US
dc.identifier.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84865054223&origin=inwarden_US
dc.identifier.urihttp://cmuir.cmu.ac.th/jspui/handle/6653943832/51257-
dc.description.abstractBackground: Data on determinants of long-term disease progression in HIV-infected patients on antiretroviral therapy (ART) are limited in low and middle-income settings. Methods: Effects of current CD4 count, viral load and haemoglobin and diagnosis of AIDS-defining events (ADEs) after start of combination ART (cART) on death and new ADEs were assessed using Poisson regression, in patient aged ≥18 years within a multi-centre cohort in Thailand. Results: Among 1,572 patients, median follow-up from cART initiation was 4.4 (IQR 3.6-6.3) years. The 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. Analysis of new ADE included 192 events during 5,865 person-years; TB and Pneumocystis jiroveci pneumonia were the most commonly presented first new ADE (35% and 20% of cases, respectively). In multivariable analyses, low current CD4 count after starting cART was the strongest predictor of death and of new ADE. Even at CD4 above 200 cells/mm3, survival improved steadily with CD4, with mortality rare at ≥500 cells/mm3 (rate 1.1 per 1,000 person-years). Haemoglobin had a strong independent effect, while viral load was weakly predictive with poorer prognosis only observed at ≥100,000 copies/ml. Mortality risk increased following diagnosis of ADEs during cART. The decline in mortality rate with duration on cART (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 CD4 count. Conclusions: Patients with low CD4 count or haemoglobin require more intensive diagnostic and treatment of underlying causes. Maintaining CD4≥500 cells/mm3 minimizes mortality. However, patient monitoring could potentially be relaxed at high CD4 count if resources are limited. Optimal ART monitoring strategies in low-income settings remain a research priority. Better understanding of the aetiology of anaemia in patients on ART could guide prevention and treatment. © 2012 Duong et al.en_US
dc.subjectAgricultural and Biological Sciencesen_US
dc.subjectBiochemistry, Genetics and Molecular Biologyen_US
dc.titleLaboratory and clinical predictors of disease progression following initiation of combination therapy in HIV-infected adults in Thailanden_US
dc.typeJournalen_US
article.title.sourcetitlePLoS ONEen_US
article.volume7en_US
article.stream.affiliationsIRD Institut de Recherche pour le Developpementen_US
article.stream.affiliationsLondon School of Hygiene & Tropical Medicineen_US
article.stream.affiliationsChiang Mai Universityen_US
article.stream.affiliationsHarvard School of Public Healthen_US
article.stream.affiliationsUniversite Paris Descartesen_US
article.stream.affiliationsChiangrai Prachanukroh Hospitalen_US
article.stream.affiliationsMae Chan Hospitalen_US
article.stream.affiliationsNakornping Hospitalen_US
article.stream.affiliationsRayong Hospitalen_US
article.stream.affiliationsBuddhachinaraj Hospitalen_US
article.stream.affiliationsMahasarakam Hospitalen_US
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