J Korean Med Sci.  2013 Jul;28(7):990-997. 10.3346/jkms.2013.28.7.990.

Causes of Death and Risk Factors for Mortality among HIV-Infected Patients Receiving Antiretroviral Therapy in Korea

• Lee SH
• Kim KH
• Lee SG
• Cho H
• Chen DH
• Chung JS
• Kwak IS
• Cho GJ

• KMID: 1777493
• DOI: http://doi.org/10.3346/jkms.2013.28.7.990

Abstract

A retrospective study was conducted to determine the mortality, causes and risk factors for death among HIV-infected patients receiving antiretroviral therapy (ART) in Korea. The outcomes were determined by time periods, during the first year of ART and during 1-5 yr after ART initiation, respectively. Patients lost to follow-up were traced to ascertain survival status. Among 327 patients initiating ART during 1998-2006, 68 patients (20.8%) died during 5-yr follow-up periods. Mortality rate per 100 person-years was 8.69 (95% confidence interval, 5.68-12.73) during the first year of ART, which was higher than 4.13 (95% confidence interval, 2.98-5.59) during 1-5 yr after ART. Tuberculosis was the most common cause of death in both periods (30.8% within the first year of ART and 16.7% during 1-5 yr after ART). During the first year of ART, clinical category B and C at ART initiation, and underlying malignancy were significant risk factors for mortality. Between 1 and 5 yr after ART initiation, CD4 cell count < or = 50 cells/microL at ART initiation, hepatitis B virus co-infection, and visit constancy < or = 50% were significant risk factors for death. This suggests that different strategies to reduce mortality according to the time period after ART initiation are needed.

Keyword

HIV; Antiretroviral Therapy; Mortality; Cause of Death; Risk Factors; Loss to Follow-up; Retention in Care; Visit Constancy

MeSH Terms

Anti-Retroviral Agents/*adverse effects/*therapeutic use
Antiretroviral Therapy, Highly Active/adverse effects
CD4 Lymphocyte Count
Cause of Death
Coinfection
Female
HIV Infections/*drug therapy/*mortality/virology
Humans
Male
Middle Aged
Republic of Korea
Retrospective Studies
Risk Factors
Treatment Outcome
Anti-Retroviral Agents

Figure

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  Fig. 1 Examples of measuring visit constancy and observation period, and 5 yr follow-up status of 327 patients included in analyses, according to the patterns of healthcare usage. Quarterly tracing of attendance (shaded boxes) and missed appointment (white boxes) with tracing results: alive (circles), dead (X), and transfer-out (T). *with or without gaps in care.

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