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Predictors of death within six months in patients with advanced AIDS

Published online by Cambridge University Press:  13 April 2006

JOHN R. BRECHTL ,
PATRICIA A. PATRICK ,
PAUL VISINTAINER  and
DONALD A. BRAND
JOHN R. BRECHTL
Affiliation:
Terence Cardinal Cooke Health Care Center, New York, New York, USA Department of Medicine, New York Medical College, Valhalla, New York, USA
PATRICIA A. PATRICK
Affiliation:
Department of Medicine, New York Medical College, Valhalla, New York, USA Primary Care Research Unit, New York Medical College, Valhalla, New York, USA
PAUL VISINTAINER
Affiliation:
School of Public Health, New York Medical College, Valhalla, New York, USA
DONALD A. BRAND
Affiliation:
Department of Medicine, New York Medical College, Valhalla, New York, USA Primary Care Research Unit, New York Medical College, Valhalla, New York, USA
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Abstract

Objectives: This study sought to identify potential predictive variables of death within 6 months in patients with advanced AIDS.

Methods: Investigators enrolled a consecutive series of patients with advanced AIDS admitted to a skilled nursing facility in New York City over a 1-year period. Demographic, clinical, laboratory, and outcome data were abstracted from medical records using a standardized data collection instrument.

Results: Of the 152 patients enrolled during the study period, 61 patients (40%) died within 6 months from date of admission. Serum albumin, percent deviation from ideal body weight, and number of comorbidities at the time of admission proved to be the best combination of predictors of death within 6 months.

Significance of results: The decrease in AIDS mortality over the past decade, along with an increase in prevalence due to longer survival, has been attributed primarily to the successful use of highly active antiretroviral therapy (HAART). HAART regimens, however, can also produce both short-term adverse effects and long-term complications. The prognostic model developed by this study may be useful in guiding treatment decisions in patients with advanced AIDS for whom a more palliative care plan may be sought.

Keywords

Acquired Immunodeficiency Syndrome/mortalityAdultAntiretroviral therapyHighly activeDecision makingPalliative care
Type
ORIGINAL ARTICLES
Information
Palliative & Supportive Care , Volume 3 , Issue 4 , December 2005 , pp. 265 - 272
Copyright
© 2005 Cambridge University Press

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References

REFERENCES

Brechtl, J., Breitbart, W., Galietta, M., et al. (2001). The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on medical, palliative care, and quality of life outcomes. Journal of Pain and Symptom Management, 21, 41–51.Google Scholar
Carrasco, D.A. & Tyring, S.K. (2001). Advances in HIV treatment and treatment toxicities. Dermatologic Clinics, 19, 757–772.Google Scholar
Centers for Disease Control and Prevention (2000). HIV/AIDS Surveillance Supplemental Report: HIV/AIDS in Urban and Nonurban Areas of the United States. Report No. 6(2).
Centers for Disease Control and Prevention (1992). Morbidity and Mortality Weekly Report: 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Report No. 41 (RR-17).
Centers for Disease Control and Prevention (2005). National Center for Health Statistics: National Death Index. Available at: http://www.cdc.gov/nchs/r&d/ndi/ndi.htm.
Cozzi Lepri, A., Katzenstein, T.L., Ullum, H., et al. (1998). The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection. AIDS, 12, 1639–1643.Google Scholar
d'Arminio Monforte, A., Testa, L., Adorni, F., et al. (1998). Clinical outcome and predictive factors of failure of highly active antiretroviral therapy in antiretroviral-experienced patients in advanced stages of HIV-1 infection. AIDS, 12, 1631–1637.Google Scholar
Detels, R., Munoz, A., McFarlane, G., et al. (1998). Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Journal of the American Medical Association, 280, 1497–1503.Google Scholar
Duong, M., Petit, J.M., Piroth, L., et al. (2001). Association between insulin resistance and hepatitis C virus chronic infection in HIV-hepatitis C virus-coinfected patients undergoing antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 27, 245–250.Google Scholar
Friedland, G.H., Saltzman, B., Vileno, J., et al. (1992). Survival differences in patients with AIDS. Journal of Acquired Immune Deficiency Syndromes, 5, 1276–1277.Google Scholar
Gallant, J.E. (2000). Strategies for long-term success in the treatment of HIV infection. Journal of the American Medical Association, 283, 1329–1334.Google Scholar
Hanson, D.L., Horsburgh, C.R., Fann, S.A., et al. (2002). Survival prognosis of HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 6, 624–629.Google Scholar
HIV Surrogate Marker Collaborative Group. (2000). Human immunodeficiency virus type 1 RNA level and CD4 count as prognostic markers and surrogate end points: A meta-analysis. AIDS Research and Human Retroviruses, 16, 1123–1133.Google Scholar
Hosmer, D.W. & Lemeshow, S. (2000). Applied Logistic Regression, 2nd ed. New York: John Wiley & Sons.
Jain, R.G., Furfine, E.S., Pedneault, L., et al. (2001). Metabolic complications associated with antiretroviral therapy. Antiviral Research, 51, 151–177.Google Scholar
Max, B. & Sherer, R. (2000). Management of the adverse effects of antiretroviral therapy and medication adherence. Clinical Infectious Diseases, 30, S96–S116.Google Scholar
Mellors, J.W., Munoz, A., Giorgi, J.V., et al. (1997). Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Annals of Internal Medicine, 126, 946–954.Google Scholar
Mellors, J.W., Rinaldo, C.R., Gupta, P., et al. (1996). Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science, 272, 1167–1170.Google Scholar
Mocroft, A.J., Johnson, M.A., Sabin, C.A., et al. (1995). Staging system for clinical AIDS patients. Lancet, 346, 12–17.Google Scholar
Moore, R.D. & Chaisson, R.E. (1999). Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS, 13, 1933–1942.Google Scholar
O'Brien, W.A., Hartigan, P.M., Martin, D., et al. (1996). Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of progression to AIDS. New England Journal of Medicine, 334, 426–431.Google Scholar
Palella, F.J., Delaney, K.M., Moorman, A.C., et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. New England Journal of Medicine, 338, 853–860.Google Scholar
Reisler, K. (2001). High hepatotoxicity rate seen among HAART patients. Aids Alert, 16, 118–119.Google Scholar
Sabin, C.A., Griffioen, A., Yee, T.T., et al. (2002). Markers of HIV-1 disease progression in individuals with haemophilia coinfected with hepatitis C virus: A longitudinal study. Lancet, 360, 1546–1551.Google Scholar
Salomon, J., de Truchis, P., & Melchior, J.C. (2002). Body composition and nutritional parameters in HIV and AIDS patients. Clinical Chemistry and Laboratory Medicine, 40, 1329–1333.Google Scholar
Sansone, G.R. & Frengley, J.D. (2000). Impact of HAART on causes of death of persons with late-stage AIDS. Journal of Urban Health, 7, 166–175.Google Scholar
Spino, C., Kahn, J.O., Dolin, R., & Phair, J.P. (1997). Predictors of survival in HIV-infected persons with 50 or fewer CD4 cells/mm3. Journal of Acquired Immune Deficiency Syndromes, 15, 346–355.Google Scholar
StataCorp (1997). Stata Statistical Software (Version 6.0) [Computer software]. College Station, TX.
Teno, J.M., Clarridge, B.R., Casey, V., et al. (2004). Family perspectives on end-of-life care at the last place of care. Journal of the American Medical Association, 291, 88–93.Google Scholar
Turner, B.J., Markson, L., & Taroni, F. (1996). Estimation of survival after AIDS diagnosis: CD4 T lymphocyte count versus clinical severity. Journal of Clinical Epidemiology, 49, 59–65.Google Scholar
Welch, K., Morse, & A., Adult Spectrum of Disease Project in New Orleans. (2002). The clinical profile of end-stage AIDS in the era of highly active antiretroviral therapy. AIDS Patient Care and STDS, 16, 75–81.Google Scholar
Wheat, L.J., Chetchotisakd, P., Williams, B., et al. (2002). Factors associated with severe manifestations of histoplasmosis in AIDS. Clinical Infectious Diseases, 30, 877–881.Google Scholar
Wilkes, G.M. (1999). Cancer and HIV Clinical Nutrition: Pocket Guide, 2nd Ed. Sudbury, MA: Jones and Bartlett.