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. 2019 Apr 1;80(4):436-443.
doi: 10.1097/QAI.0000000000001933.

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

Mark Kristoffer U Pasayan  1 , Mary Lorraine S Mationg  1 , David Boettiger  2 , Wilson Lam  3 , Fujie Zhang  4 , Stephane Wen-Wei Ku  5 , Tuti Parwati Merati  6 , Romanee Chaiwarith  7 , Do Duy Cuong  8 , Evy Yunihastuti  9 , Sasisopin Kiertiburanakul  10 , Nguyen Van Kinh  11 , Anchalee Avihingsanon  12 , Ly Penh Sun  13 , Adeeba Kamarulzaman  14 , Pacharee Kantipong  15 , Nagalingeswaran Kumarasamy  16 , Sanjay Pujari  17 , Benedict Lim Heng Sim  18 , Oon Tek Ng  19 , Jun Yong Choi  20 , Junko Tanuma  21 , Jeremy Ross  22 , Rossana A Ditangco  1
Affiliations

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

Mark Kristoffer U Pasayan et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Mycobacterium avium complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated Mycobacterium avium 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.

Methods: Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count <50 cells/mm 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 <100 cells/mm at ART initiation.

Results: 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, P = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, P = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 <100 cells/mm at ART initiation.

Conclusions: 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.

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Conflict of interest statement

Declaration of Conflicts of Interest and Sources of Funding

Mark Kristoffer U. Pasayan – none

Mary Lorraine S. Mationg – none

David Boettiger – none

Wilson Lam – none

Fujie Zhang – none

Stephane Wen-Wei Ku – none

Tuti Parwati Merati – none

Romanee Chaiwarith – none

Do Duy Cuong – none

Evy Yunihastuti – none

Sasisopin Kiertiburanakul – none

Nguyen Van Kinh – none

Anchalee Avihingsanon – none

Ly Penh Sun – none

Adeeba Kamarulzaman – none

Pacharee Kantipong – none

Nagalingeswaran Kumarasamy – none

Sanjay Pujari – none

Benedict Lim Heng Sim – none

Oon Tek Ng – none

Jun Yong Choi – none

Junko Tanuma – none

Jeremy Ross – none

Rossana Ditangco – none

on behalf of the TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific

The TREAT Asia HIV Observational Database is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above.

Figures

Figure 1.
Figure 1.
Patients with CD4 cell count <50 cells/mm3 at antiretroviral therapy initiation: cumulative probabilities of a) AIDS-defining condition or HIV-associated mortality by macrolide use and b) HIV-associated mortality by macrolide use.
See this image and copyright information in PMC

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