{"doi":"10.1093/cid/ciaf560","title":"Predictive Value of C-reactive Protein for Hospitalization and Mortality Among People With Advanced HIV Disease in Uganda Receiving the World Health Organization-recommended Package of Care","abstract":"BACKGROUND: People with advanced human immunodeficiency virus (HIV) disease (CD4 ≤ 200 cells/µL) remain at high risk for opportunistic infections, hospitalization, and death, despite access to antiretroviral therapy (ART). We evaluated serum C-reactive protein (CRP) as a predictor of 30-day hospitalization or death among outpatients with advanced HIV disease. METHODS: We prospectively enrolled 1388 outpatient Ugandan adults with CD4 ≤ 200 cells/µL from May 2022 to February 2025, of whom 1378 had serum CRP measured at enrollment. Participants were ART-naïve or experienced, and people with known virologic suppression were excluded. Participants received tuberculosis and cryptococcosis screening and therapy per World Health Organization (WHO) recommendations. We examined CRP as a continuous and dichotomized predictor (≥10 mg/L) of 30-day hospitalization or death. RESULTS: Among 1378 participants, 41.6% had CRP ≥10 mg/L. Participants with CRP ≥10 mg/L were more likely to be hospitalized (relative risk = 4.2, 95% CI: 2.3-7.8) or die (relative risk = 9.8, 95% CI: 2.9-32.8) within 30 days. In a multivariable Cox model adjusted for weight, CD4 count, ART status, and age, each 2-fold increase in CRP was associated with a 36.9% higher hazard of 30-day hospitalization or death (hazard ratio = 1.4, 95% CI: 1.2-1.5). Including CRP in the multivariable model significantly improved prediction of 30-day hospitalization or death (AUC 0.80 with CRP vs 0.72 without, DeLong's P = .009). CONCLUSIONS: CRP ≥10 mg/L is associated with increased risk of 30-day hospitalization or death among outpatients with advanced HIV disease receiving the WHO-recommended package of care. Prospective studies should evaluate whether point-of-care CRP testing can enable real-time risk stratification to reduce AIDS-related deaths.","journal":"Clinical Infectious Diseases","year":2025,"id":577173,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9621,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":910915,"name":"Elizabeth Nalintya","orcid":null,"position":1,"is_corresponding":false},{"id":267647,"name":"Caleb P Skipper","orcid":"0000-0002-0000-8876","position":2,"is_corresponding":false},{"id":1486721,"name":"Patricia Nerima","orcid":null,"position":3,"is_corresponding":false},{"id":444819,"name":"Ann Fieberg","orcid":null,"position":4,"is_corresponding":false},{"id":1486722,"name":"Olive Loryndah Namakula","orcid":null,"position":5,"is_corresponding":false},{"id":1025678,"name":"Biyue Dai","orcid":"0000-0002-4747-3687","position":6,"is_corresponding":false},{"id":397657,"name":"David B. Meya","orcid":"0000-0002-8854-0321","position":7,"is_corresponding":false},{"id":267658,"name":"David R. Boulware","orcid":"0000-0002-4715-0060","position":8,"is_corresponding":false},{"id":267644,"name":"Radha Rajasingham","orcid":"0000-0001-5531-0231","position":9,"is_corresponding":false},{"id":1486374,"name":"Elizabeth L Schwartz","orcid":"0000-0002-9550-0635","position":0,"is_corresponding":true}],"reference_count":22,"raw_metadata":null,"created_at":"2026-07-19T02:58:04.622308Z","pmid":"41057277","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}