Impact of opportunistic disease on survival in patients with HIV infection

Research output: Contribution to journalArticle

Abstract

Objective: To assess the impact of opportunistic diseases on survival in patients with HIV disease. Methods: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. Results: During follow-up, 730 (35%) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independently of CD4 cell count (all P <0.001 for opportunistic diseases controlling for CD4 cell count). The magnitude of increased risk was greatest for lymphoma [relative hazard (RH), 7.2], PML (RH, 3.9), MAC (RH, 3.0) and CMV (RH, 2.2). Cryptococcosis (RH, 0.94) and herpes zoster (RH, 0.85) were not associated with death. In a multivariate Cox proportional hazards analysis, MAC [RH, 2.56; 95% confidence interval (CI), 2.1-3.1], CMV (RH, 1.63; 95% CI, 1.3-2.1), toxoplasmosis (RH, 1.85; 95% CI, 1.3-2.6), PCP (RH, 1.29; 95% CI, 1.1-1.5), and CD4 cell count were significantly greatly monthly declines in CD4 counts (-11 x 106/l per month) than those who did not (-6 x 106/l per month; P <0.001). Conclusion: Most opportunistic diseases increase the risk of death independently of CD4 cell count. These data support the hypothesis that opportunistic diseases enhance HIV pathogenesis and further underscore the importance of prophylaxis.

Original languageEnglish (US)
Pages (from-to)29-33
Number of pages5
JournalAIDS
Volume12
Issue number1
DOIs
StatePublished - Jan 1 1998

Fingerprint

HIV Infections
CD4 Lymphocyte Count
Survival
Mycobacterium avium Complex
Cytomegalovirus
Confidence Intervals
Progressive Multifocal Leukoencephalopathy
Pneumocystis Pneumonia
Toxoplasmosis
Lymphoma
HIV
Cryptosporidiosis
Cryptococcosis
Esophagitis
Kaposi's Sarcoma
Herpes Zoster
Candida
Dementia

Keywords

  • CD4 lymphocytes
  • HIV
  • Natural history
  • Opportunistic infections
  • Survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Impact of opportunistic disease on survival in patients with HIV infection. / Chaisson, Richard E; Gallant, Joel E.; Keruly, Jeanne C; Moore, Richard D.

In: AIDS, Vol. 12, No. 1, 01.01.1998, p. 29-33.

Research output: Contribution to journalArticle

@article{78483d4c249a4e7ba710351bd3319267,
title = "Impact of opportunistic disease on survival in patients with HIV infection",
abstract = "Objective: To assess the impact of opportunistic diseases on survival in patients with HIV disease. Methods: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. Results: During follow-up, 730 (35{\%}) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independently of CD4 cell count (all P <0.001 for opportunistic diseases controlling for CD4 cell count). The magnitude of increased risk was greatest for lymphoma [relative hazard (RH), 7.2], PML (RH, 3.9), MAC (RH, 3.0) and CMV (RH, 2.2). Cryptococcosis (RH, 0.94) and herpes zoster (RH, 0.85) were not associated with death. In a multivariate Cox proportional hazards analysis, MAC [RH, 2.56; 95{\%} confidence interval (CI), 2.1-3.1], CMV (RH, 1.63; 95{\%} CI, 1.3-2.1), toxoplasmosis (RH, 1.85; 95{\%} CI, 1.3-2.6), PCP (RH, 1.29; 95{\%} CI, 1.1-1.5), and CD4 cell count were significantly greatly monthly declines in CD4 counts (-11 x 106/l per month) than those who did not (-6 x 106/l per month; P <0.001). Conclusion: Most opportunistic diseases increase the risk of death independently of CD4 cell count. These data support the hypothesis that opportunistic diseases enhance HIV pathogenesis and further underscore the importance of prophylaxis.",
keywords = "CD4 lymphocytes, HIV, Natural history, Opportunistic infections, Survival",
author = "Chaisson, {Richard E} and Gallant, {Joel E.} and Keruly, {Jeanne C} and Moore, {Richard D}",
year = "1998",
month = "1",
day = "1",
doi = "10.1097/00002030-199801000-00004",
language = "English (US)",
volume = "12",
pages = "29--33",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Impact of opportunistic disease on survival in patients with HIV infection

AU - Chaisson, Richard E

AU - Gallant, Joel E.

AU - Keruly, Jeanne C

AU - Moore, Richard D

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Objective: To assess the impact of opportunistic diseases on survival in patients with HIV disease. Methods: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. Results: During follow-up, 730 (35%) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independently of CD4 cell count (all P <0.001 for opportunistic diseases controlling for CD4 cell count). The magnitude of increased risk was greatest for lymphoma [relative hazard (RH), 7.2], PML (RH, 3.9), MAC (RH, 3.0) and CMV (RH, 2.2). Cryptococcosis (RH, 0.94) and herpes zoster (RH, 0.85) were not associated with death. In a multivariate Cox proportional hazards analysis, MAC [RH, 2.56; 95% confidence interval (CI), 2.1-3.1], CMV (RH, 1.63; 95% CI, 1.3-2.1), toxoplasmosis (RH, 1.85; 95% CI, 1.3-2.6), PCP (RH, 1.29; 95% CI, 1.1-1.5), and CD4 cell count were significantly greatly monthly declines in CD4 counts (-11 x 106/l per month) than those who did not (-6 x 106/l per month; P <0.001). Conclusion: Most opportunistic diseases increase the risk of death independently of CD4 cell count. These data support the hypothesis that opportunistic diseases enhance HIV pathogenesis and further underscore the importance of prophylaxis.

AB - Objective: To assess the impact of opportunistic diseases on survival in patients with HIV disease. Methods: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. Results: During follow-up, 730 (35%) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independently of CD4 cell count (all P <0.001 for opportunistic diseases controlling for CD4 cell count). The magnitude of increased risk was greatest for lymphoma [relative hazard (RH), 7.2], PML (RH, 3.9), MAC (RH, 3.0) and CMV (RH, 2.2). Cryptococcosis (RH, 0.94) and herpes zoster (RH, 0.85) were not associated with death. In a multivariate Cox proportional hazards analysis, MAC [RH, 2.56; 95% confidence interval (CI), 2.1-3.1], CMV (RH, 1.63; 95% CI, 1.3-2.1), toxoplasmosis (RH, 1.85; 95% CI, 1.3-2.6), PCP (RH, 1.29; 95% CI, 1.1-1.5), and CD4 cell count were significantly greatly monthly declines in CD4 counts (-11 x 106/l per month) than those who did not (-6 x 106/l per month; P <0.001). Conclusion: Most opportunistic diseases increase the risk of death independently of CD4 cell count. These data support the hypothesis that opportunistic diseases enhance HIV pathogenesis and further underscore the importance of prophylaxis.

KW - CD4 lymphocytes

KW - HIV

KW - Natural history

KW - Opportunistic infections

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=0031983473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031983473&partnerID=8YFLogxK

U2 - 10.1097/00002030-199801000-00004

DO - 10.1097/00002030-199801000-00004

M3 - Article

C2 - 9456252

AN - SCOPUS:0031983473

VL - 12

SP - 29

EP - 33

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 1

ER -