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Pasayan, Mark Kristoffer U.; S. Mationg, Mary Lorraine; Boettiger, David; Lam, Wilson; Zhang, Fujie; Ku, Stephane Wen-Wei; Merati, Tuti Parwati; Chaiwarith, Romanee; Cuong, Do Duy; Yunihastuti, Evy; Kiertiburanakul, Sasisopin; Van Kinh, Nguyen; Avihingsanon, Anchalee; Sun, Ly Penh; Kamarulzaman, Adeeba; Kantipong, Pacharee; Kumarasamy, Nagalingeswaran; Pujari, Sanjay; Heng Sim, Benedict Lim; Ng, Oon Tek; Choi, Jun Yong; Tanuma, Junko; Ross, Jeremy; A. Ditangco, Rossana

Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Associated Mortality

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  • Media type: E-Article
  • Title: Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Associated Mortality
  • Contributor: Pasayan, Mark Kristoffer U.; S. Mationg, Mary Lorraine; Boettiger, David; Lam, Wilson; Zhang, Fujie; Ku, Stephane Wen-Wei; Merati, Tuti Parwati; Chaiwarith, Romanee; Cuong, Do Duy; Yunihastuti, Evy; Kiertiburanakul, Sasisopin; Van Kinh, Nguyen; Avihingsanon, Anchalee; Sun, Ly Penh; Kamarulzaman, Adeeba; Kantipong, Pacharee; Kumarasamy, Nagalingeswaran; Pujari, Sanjay; Heng Sim, Benedict Lim; Ng, Oon Tek; Choi, Jun Yong; Tanuma, Junko; Ross, Jeremy; A. Ditangco, Rossana
  • Published: Ovid Technologies (Wolters Kluwer Health), 2019
  • Published in: JAIDS Journal of Acquired Immune Deficiency Syndromes, 80 (2019) 4, Seite 436-443
  • Language: English
  • DOI: 10.1097/qai.0000000000001933
  • ISSN: 1525-4135
  • Keywords: Pharmacology (medical) ; Infectious Diseases
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>Background:</jats:title> <jats:p> <jats:italic toggle="yes">Mycobacterium avium</jats:italic> complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated <jats:italic toggle="yes">Mycobacterium avium</jats:italic> complex infection and the availability of antiretroviral therapy (ART), the benefits of macrolide prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count &lt;50 cells/mm<jats:sup>3</jats:sup> at ART initiation were included. The effect of macrolide prophylaxis on HIV-associated mortality or AIDS-defining conditions (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted in patients with a CD4 &lt;100 cells/mm<jats:sup>3</jats:sup> at ART initiation.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Of 1345 eligible patients, 10.6% received macrolide prophylaxis. The rate of the combined outcome was 7.35 [95% confidence interval (CI): 6.04 to 8.95] per 100 patient-years, whereas the rate of HIV-associated mortality was 3.14 (95% CI: 2.35 to 4.19) per 100 patient-years. Macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio 0.10, 95% CI: 0.01 to 0.80, <jats:italic toggle="yes">P</jats:italic> = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, <jats:italic toggle="yes">P</jats:italic> = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 &lt;100 cells/mm<jats:sup>3</jats:sup> at ART initiation.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Macrolide prophylaxis is associated with improved survival among Asian HIV-infected patients with low CD4 cell counts and on ART. This study suggests the increased usage and coverage of macrolide prophylaxis among people living with HIV in Asia.</jats:p> </jats:sec>
  • Access State: Open Access