Document Detail


Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda.
MedLine Citation:
PMID:  21857358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Up to 20% of people initiating antiretroviral therapy (ART) in sub-Saharan Africa die during the first year of treatment. Understanding the clinical conditions associated with mortality could potentially lead to effective interventions to prevent these deaths.
METHODS: We examined data from participants aged ≥18 years in the Home-Based AIDS Care project in Tororo, Uganda, to describe mortality over time and to determine clinical conditions associated with death. Survival analysis was used to examine variables associated with mortality at baseline and during follow-up.
RESULTS: A total of 112 (9.4%) deaths occurred in 1132 subjects (73% women) during a median of 3.0 years of ART. Mortality was 15.9 per 100 person-years during the first 3 months and declined to 0.3 per 100 person-years beyond 24 months after ART initiation. Tuberculosis (TB) was the most common condition associated with death (21% of deaths), followed by Candida disease (15%). In 43% of deaths, no specific clinical diagnosis was identified. Deaths within 3 months after ART initiation were associated with World Health Organization clinical stage III or IV at baseline, diagnosis of TB at baseline, a diagnosis of a non-TB opportunistic infection in follow-up and a body mass index ≤17 kg/m² during follow-up. Mortality after 3 months of ART was associated with CD4 cell counts <200 cells per microliter, a diagnosis of TB or other opportunistic infection, adherence to therapy <95%, and low hemoglobin levels during follow-up.
CONCLUSION: Potentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.
Authors:
David M Moore; Constantin T Yiannoutsos; Beverly S Musick; Jordan Tappero; Richard Degerman; James Campbell; Willy Were; Frank Kaharuza; Lorraine N Alexander; Robert Downing; Jonathan Mermin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  58     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-18     Completed Date:  2011-12-07     Revised Date:  2013-09-20    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  289-96     Citation Subset:  IM; X    
Affiliation:
Global AIDS Program, US Centers for Disease Control and Prevention (CDC), Entebbe, Uganda. dmoore@cfenet.ubc.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Retroviral Agents / administration & dosage*
Antiretroviral Therapy, Highly Active / methods*
Female
HIV Infections / drug therapy,  mortality*
Humans
Male
Middle Aged
Risk Factors
Rural Population
Survival Analysis
Uganda
Young Adult
Grant Support
ID/Acronym/Agency:
AI 69911/AI/NIAID NIH HHS; U01 AI069911/AI/NIAID NIH HHS; //Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents
Comments/Corrections

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