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Hyponatremia, Hypochloremia, and Hypoalbuminemia Predict an Increased Risk of Mortality during the First Year of Antiretroviral Therapy among HIV-infected Zambian and Kenyan Women.
MedLine Citation:
PMID:  21417949     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Early mortality rates after initiating antiretroviral therapy (ART) are high in sub-Saharan Africa. We examined whether serum chemistries at ART initiation predicted mortality among HIV-infected women. Methods: From May 2005-January 2007, we enrolled women initiating ART in a prospective cohort study in Zambia and Kenya. We used Cox proportional hazards models to identify risk factors associated with mortality. Results: Among 661 HIV-infected women, 53 (8%) died during the first year of ART, and tuberculosis was the most common cause of death (32%). Women were more likely to die if they were both hyponatremic (sodium < 135 mmol/L) and hypochloremic (chloride < 95 mmol/L) (37% vs. 6%) or hypoalbuminemic (albumin < 34 g/L, 13% vs. 4%) when initiating ART. A body mass index < 18 kg/m2 (adjusted hazard ratio [aHR] 5.3, 95% confidence interval [CI] 2.6-10.6) and hyponatremia with hypochloremia (aHR 4.5, 95% CI 2.2-9.4) were associated with one-year mortality after adjusting for country, CD4 cell count, WHO clinical stage, hemoglobin, and albumin. Among women with a CD4 cell count >50 cells/µL, hypoalbuminemia was also a significant predictor of mortality (aHR = 3.7, 95% CI 1.4 - 9.8) Conclusions: Baseline hyponatremia with hypochloremia and hypoalbuminemia predicted mortality in the first year of initiating ART, and these abnormalities might reflect opportunistic infections (e.g., tuberculosis) or advanced HIV disease. Assessment of serum sodium, chloride, and albumin can identify HIV-infected patients at highest risk for mortality who may benefit from more intensive medical management during the first year of ART.
Authors:
Christine N Dao; Philip J Peters; James Kiarie; Jeffrey Stringer; Isaac Zulu; Peter Muiruri; John Ong'ech; Winfred Mutsotso; Dara Potter; Lungowe Njobvu; Craig B Borkowf; Omotayo Bolu; Paul Weidle
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-22
Journal Detail:
Title:  AIDS research and human retroviruses     Volume:  -     ISSN:  1931-8405     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8709376     Medline TA:  AIDS Res Hum Retroviruses     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States; christinendao@gmail.com.
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