Document Detail


Strategies to reduce early morbidity and mortality in adults receiving antiretroviral therapy in resource-limited settings.
MedLine Citation:
PMID:  20046144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: We review recently published literature concerning early morbidity and mortality during antiretroviral therapy (ART) among patients in resource-limited settings. We focus on articles providing insights into this burden of disease and strategies to address it.
RECENT FINDINGS: In sub-Saharan Africa, mortality rates during the first year of ART are very high (8-26%), with most deaths occurring in the first few months. This figure compares with 3-13% in programmes in Latin America and the Caribbean and 11-13% in south-east Asia. Risk factors generally reflect late presentation with advanced symptomatic disease. Key causes of morbidity and mortality include tuberculosis (TB), acute sepsis, cryptococcal meningitis, malignancy and wasting syndrome/chronic diarrhoea. Current literature shows that the fundamental need is for much earlier HIV diagnosis and initiation of ART. In addition, further studies provide data on the role of screening and prophylaxis against opportunistic diseases (particularly TB, bacterial sepsis and cryptococcal disease) and the management of specific opportunistic diseases and complications of ART. Effective and sustainable delivery of these interventions requires strengthening of programmes.
SUMMARY: Strategies to address this disease burden should include earlier HIV diagnosis and ART initiation, screening and prophylaxis for opportunistic infections, optimized management of specific diseases and treatment complications, and programme strengthening.
Authors:
Stephen D Lawn; Anthony D Harries; Robin Wood
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in HIV and AIDS     Volume:  5     ISSN:  1746-6318     ISO Abbreviation:  Curr Opin HIV AIDS     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-04     Completed Date:  2010-03-12     Revised Date:  2013-09-17    
Medline Journal Info:
Nlm Unique ID:  101264945     Medline TA:  Curr Opin HIV AIDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-26     Citation Subset:  IM; X    
Affiliation:
Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. stevelawn@yahoo.co.uk
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections* / drug therapy,  epidemiology,  mortality
Adult
Anti-HIV Agents / administration & dosage,  therapeutic use*
Developing Countries*
HIV Infections / complications*,  drug therapy,  epidemiology,  mortality*
HIV-1 / drug effects
Humans
Meningitis, Cryptococcal / drug therapy,  epidemiology,  mortality
Morbidity
Randomized Controlled Trials as Topic
Treatment Outcome
Tuberculosis / drug therapy,  epidemiology,  mortality
Grant Support
ID/Acronym/Agency:
1U19AI53217-01/AI/NIAID NIH HHS; A1058736-01A1//PHS HHS; R01 AI058736/AI/NIAID NIH HHS; R01 AI058736-01A1/AI/NIAID NIH HHS; U19 AI053217/AI/NIAID NIH HHS; //Wellcome Trust
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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