1816. Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Related Mortality
Session: Oral Abstract Session: HIV: Co-morbidities and Co-infections
Saturday, October 7, 2017: 11:45 AM
Room: 08
Background:

Mycobacterium avium-intracelllulare complex (MAC) prophylaxis is recommended for patients with CD4 counts of <50 cells/mm3. With the significant decrease in incidence of disseminated MAC infection and the effective immune recovery due to the availability of combination antiretroviral therapy (ART), the benefits of giving MAC 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.

Methods:

TREAT Asia HIV Observational Database (TAHOD) patients aged ≥18 years with a CD4 count <50 cells/mm3 at ART initiation were included. The effect of macrolide prohylaxis on HIV-associated mortality or an AIDS event (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted to assess whether results were consistent in patients with a CD4 <100 cells/mm3 at ART initiation.

Results:

Of 1,345 eligible patients (78% male with median age at ART initiation of 34.8 years), 10.6% received macrolide prophylaxis. The rates of the combined outcome and HIV-associated mortality per 100 patient years were 7.35 [95% confidence interval (CI): 6.04-8.95] and 3.14 (95% CI: 2.35-4.19), respectively. After adjusting for possible confounders, macrolide use was associated with a significantly decreased risk of HIV-associated mortality (HR 0.10, 95% CI: 0.01-0.80, P=0.031) but not the combined outcome (HR 0.86, 95% CI: 0.32-2.229, P=0.764). Sensitivity analyses showed that, among patients with a CD4 <100 cells/ mm3 at ART initiation, these results were consistent.

Conclusion:

Macrolide prophylaxis is associated with significantly improved survival among Asian HIV-infected patients with very low CD4 cell counts. The benefits of giving macrolide prophylaxis remain despite the availability of effective ART.

Mark Kristoffer Pasayan, MD1, Mary Lorraine Mationg, MS1, David Boettiger, PhD2, Wilson Lam, MBChB, MRCP(UK)3, Fujie Zhang, MD4, Wen-Wei Ku, MD5, Ketut Tuti Merati, SpPD-KPTI6, Romanee Chaiwarith, MD7, Do Duy Cuong, MD8, Evy Yunihastuti, MD9, Sasisopin Kiertiburanakul, MD, MHS10, Nguyen Van Kinh, MD11, Anchalee Avihingsanon, MD, PhD12, Ly Penh Sun, MD13, Adeeba Kamarulzaman, MD14, Pacharee Kantipong, MD15, Nagalingswaran Kumarasamy, MD16, Sanjay Pujari, MD17, Benedict Lh Sim, MD18, Oon Tek Ng, MD19, Jun Yong Choi, MD, PhD20, Junko Tanuma, MD21, Jeremy Ross, MD22, Rossana Ditangco, MD1 and TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific, (1)Research Institute for Tropical Medicine, Muntinlupa, Philippines, (2)The Kirby Institute, UNSW Australia, Sydney, Australia, (3)Department of Medicine, Queen Elizabeth Hospital, Hong Kong, Hong Kong, (4)Beijing Ditan Hospital, Capital Medical University, Beijing, China, (5)Taipei Veterans General Hospital, Taipei, Taiwan, (6)Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia, (7)Internal Medicine, Faculty of Medicine Chiang Mai University, Muang, Thailand, (8)Bach Mai Hospital, Hanoi, Viet Nam, (9)9. Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, (10)Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (11)National Hospital for Tropical Diseases, Hanoi, Viet Nam, (12)HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand, (13)National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia, (14)University Malaya Medical Centre, Kuala Lumpur, Malaysia, Kuala Lumpur, Malaysia, (15)Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, Chiang Rai, Thailand, (16)YRGCARE Medical Centre, VHS, Chennai, India, (17)Institute of Infectious Diseases, Pune, India, (18)Hospital Sungai Buloh, Sungai Buloh, Malaysia, (19)Tan Tock Seng Hospital, Singapore, Singapore, (20)Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), (21)National Center for Global Health and Medicine, Tokyo, Japan, Tokyo, Japan, (22)TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand

Disclosures:

M. K. Pasayan, None

M. L. Mationg, None

D. Boettiger, None

W. Lam, None

F. Zhang, None

W. W. Ku, None

K. T. Merati, None

R. Chaiwarith, None

D. D. Cuong, None

E. Yunihastuti, None

S. Kiertiburanakul, None

N. V. Kinh, None

A. Avihingsanon, None

L. P. Sun, None

A. Kamarulzaman, None

P. Kantipong, None

N. Kumarasamy, None

S. Pujari, None

B. L. Sim, None

O. T. Ng, None

J. Y. Choi, None

J. Tanuma, None

J. Ross, None

R. Ditangco, None

<< Previous Abstract | Next Abstract

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.