Short-Term Clinical Disease Progression in HIV-Infected Patients Receiving Combination Antiretroviral Therapy: Results from the TREAT Asia HIV Observational Database

Risk equations to identify HIV-infected patients at high risk of AIDS or death have been established on the basis of populations in developed country [1, 2]. Use of these risk equations to identify HIV-infected patients at high short-term risk of AIDS or death would allow clinicians to attempt to intervene. The risk equations can also be used to stratify patient risk in randomized clinical trials, thus ensuring unbiased treatment comparisons [2]. Factors found to be related to disease progression or death are current hemoglobin level, CD4 cell count, body mass index (BMI; calculated as the weight in kilograms divided by the square of the height in meters), previous AIDS-defining illness, and injection drug use as the mode of HIV acquisition [2–8]. Risk equations have been developed predominantly for white populations in developed countries; their validity when extrapolated to other populations in developing countries is uncertain. Furthermore, the equations rely on diagnostic tests that are routinely used in developed countries but that are not widely available in resource-limited settings; thus, the application of these equations in developing countries may be problematic. For example, the recent model developed by Mocroft et al. [2] requires multiple CD4 cell count measurements for a CD4 cell count slope to be calculated; however, measurement of CD4 cell count may not be feasible in resource-limited settings. There have been some efforts to develop simple predictive risk equations for use in resource-limited settings. The Anti-retroviral Treatment (ART) in Lower Income Countries (ART-LINC) Collaboration developed a risk equation for AIDS or death for patients who initiated HAART [9–11]. A short-term risk equation for patients receiving or not receiving ART was developed on the basis of limited follow-up data on Asian populations from the Therapeutics Research, Education, and AIDS Training in Asia HIV Observational Database (TAHOD) [7]. The purpose of this analysis was to develop short-term predictive risk equations for AIDS or death in Asian populations receiving ART with use of simple clinical data that would routinely be available in resource-limited settings.