Cover Image

Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis

Objectives: To determine predictors of disease progression in HIV-infected patients receiving treatment at the University of Malaya Medical Centre (UMMC). Methods: HIV-infected patients aged 20 years and above on treatment in the UMMC were followed up with a bidirectional cohort study starting in 2...

Full description

Saved in:
Bibliographic Details
Main Author: Rahayu Lubis, Abdullah
Format: Thesis
Published: 2013
Subjects:
R Medicine (General)
Online Access:http://studentsrepo.um.edu.my/5545/1/Thesis_Rahayu_Final.pdf
http://studentsrepo.um.edu.my/5545/
Tags: Add Tag
No Tags, Be the first to tag this record!
id my.um.stud.5545
record_format eprints
spelling my.um.stud.55452015-06-25T01:02:31Z Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis Rahayu Lubis, Abdullah R Medicine (General) Objectives: To determine predictors of disease progression in HIV-infected patients receiving treatment at the University of Malaya Medical Centre (UMMC). Methods: HIV-infected patients aged 20 years and above on treatment in the UMMC were followed up with a bidirectional cohort study starting in 2007. Patient records were investigated retrospectively to 1986 and prospectively until 2009. Kaplan Meier and Cox regression analysis were performed using SPSS. Results: A total of 1314 patients, 73.3 per cent were aged 20-39 years, 81.8 per cent male, 61.2 per cent Chinese, 45.2 per cent single, 73.5 per cent had only primary or secondary education, 43.2 per cent worked as professionals or non-manual workers, 42.5 per cent had a monthly income of RM 1000-3000. The majority had baseline CD4 less than 200 cells/μL (62.9 per cent), viral load more than 100,000 copies/ml (51.1 per cent), hemoglobin more than 12 g/dl (62.5 per cent) and normal liver function test (55.2 per cent), were infected via the heterosexual route (65.8 per cent) and were in WHO clinical stage 4 (54.2 per cent). Most initiated HAART with 2 NRTI+ EFV (57.9 per cent), did not need second line HAART (88.5 per cent), and managed to achieve viral load less than 50 copies/ml (61.5 per cent). The median time to death in all AIDS patients was 65.7 months, and 15.0 months in AIDS patients who did not receive anti-retroviral therapy. The median time to achieve viral load less than 50 copies/ml was 5.1 months. At the end of the study, 63.6 per cent of patients survived. The predictors of death in all AIDS patients were unemployment (HR 1.59; 95% CI 1.26, 2.02), manual employment (HR 1.47; 95% CI 1.15, 1.87), those who have three or more opportunistic infections (HR 1.90; 95% CI 1.39, 2.58) and those who did not receive anti-retroviral ii therapy (HR 2.89; 95% CI 2.37, 3.47). The predictors of death in AIDS patients on HAART were unemployment (HR 1.64; 95% CI 1.04, 2.57), CD4 which never recovered to more than 200 cells/μL (HR 4.03; 95% CI 2.21, 7.35), and inability to achieve viral load less than 50 copies/ml (HR 4.39; 95% CI 2.69, 7.16). Independent predictors of death for AIDS patients who did not receive anti-retroviral therapy were Chinese ethnicity (HR 1.57; 95% CI 1.15, 2.15), baseline viral load more than 100,000 copies/ml (HR 1.35; 95% CI 1.02, 1.79) and being in WHO clinical stage 4 (HR 2.25; 95% CI 1.65, 3.06). The predictors to achieve viral load less than 50 copies/ml were starting HAART with 2NRTI+EFV (HR 1.56; 95% CI 1.10, 2.20) and not needing a second line of HAART (HR 2.59; 95% CI 1.59, 4.21) and infection via injecting drug use (HR 0.54; 95% CI 0.35, 0.80) Conclusion: Every effort needs be made to ensure all HIV-infected patients in Malaysia are able to achieve a CD4 more than 200 cells/μL, viral load less than 50 copies/ml, and have access to triple drug anti-retroviral therapy as these are significant modifiable predictors of death in Malaysian HIV patients. 2013 Thesis NonPeerReviewed application/pdf http://studentsrepo.um.edu.my/5545/1/Thesis_Rahayu_Final.pdf Rahayu Lubis, Abdullah (2013) Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis. PhD thesis, University of Malaya. http://studentsrepo.um.edu.my/5545/
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Student Repository
url_provider http://studentsrepo.um.edu.my/
topic R Medicine (General)
spellingShingle R Medicine (General)
Rahayu Lubis, Abdullah
Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
description Objectives: To determine predictors of disease progression in HIV-infected patients receiving treatment at the University of Malaya Medical Centre (UMMC). Methods: HIV-infected patients aged 20 years and above on treatment in the UMMC were followed up with a bidirectional cohort study starting in 2007. Patient records were investigated retrospectively to 1986 and prospectively until 2009. Kaplan Meier and Cox regression analysis were performed using SPSS. Results: A total of 1314 patients, 73.3 per cent were aged 20-39 years, 81.8 per cent male, 61.2 per cent Chinese, 45.2 per cent single, 73.5 per cent had only primary or secondary education, 43.2 per cent worked as professionals or non-manual workers, 42.5 per cent had a monthly income of RM 1000-3000. The majority had baseline CD4 less than 200 cells/μL (62.9 per cent), viral load more than 100,000 copies/ml (51.1 per cent), hemoglobin more than 12 g/dl (62.5 per cent) and normal liver function test (55.2 per cent), were infected via the heterosexual route (65.8 per cent) and were in WHO clinical stage 4 (54.2 per cent). Most initiated HAART with 2 NRTI+ EFV (57.9 per cent), did not need second line HAART (88.5 per cent), and managed to achieve viral load less than 50 copies/ml (61.5 per cent). The median time to death in all AIDS patients was 65.7 months, and 15.0 months in AIDS patients who did not receive anti-retroviral therapy. The median time to achieve viral load less than 50 copies/ml was 5.1 months. At the end of the study, 63.6 per cent of patients survived. The predictors of death in all AIDS patients were unemployment (HR 1.59; 95% CI 1.26, 2.02), manual employment (HR 1.47; 95% CI 1.15, 1.87), those who have three or more opportunistic infections (HR 1.90; 95% CI 1.39, 2.58) and those who did not receive anti-retroviral ii therapy (HR 2.89; 95% CI 2.37, 3.47). The predictors of death in AIDS patients on HAART were unemployment (HR 1.64; 95% CI 1.04, 2.57), CD4 which never recovered to more than 200 cells/μL (HR 4.03; 95% CI 2.21, 7.35), and inability to achieve viral load less than 50 copies/ml (HR 4.39; 95% CI 2.69, 7.16). Independent predictors of death for AIDS patients who did not receive anti-retroviral therapy were Chinese ethnicity (HR 1.57; 95% CI 1.15, 2.15), baseline viral load more than 100,000 copies/ml (HR 1.35; 95% CI 1.02, 1.79) and being in WHO clinical stage 4 (HR 2.25; 95% CI 1.65, 3.06). The predictors to achieve viral load less than 50 copies/ml were starting HAART with 2NRTI+EFV (HR 1.56; 95% CI 1.10, 2.20) and not needing a second line of HAART (HR 2.59; 95% CI 1.59, 4.21) and infection via injecting drug use (HR 0.54; 95% CI 0.35, 0.80) Conclusion: Every effort needs be made to ensure all HIV-infected patients in Malaysia are able to achieve a CD4 more than 200 cells/μL, viral load less than 50 copies/ml, and have access to triple drug anti-retroviral therapy as these are significant modifiable predictors of death in Malaysian HIV patients.
format Thesis
author Rahayu Lubis, Abdullah
author_facet Rahayu Lubis, Abdullah
author_sort Rahayu Lubis, Abdullah
title Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
title_short Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
title_full Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
title_fullStr Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
title_full_unstemmed Determinants for disease progression in aids patients receiving treatment in the University Of Malaya Medical Centre / Rahayu Lubis
title_sort determinants for disease progression in aids patients receiving treatment in the university of malaya medical centre / rahayu lubis
publishDate 2013
url http://studentsrepo.um.edu.my/5545/1/Thesis_Rahayu_Final.pdf
http://studentsrepo.um.edu.my/5545/
_version_ 1738505803421188096
score 13.211869

Similar Items