Details:

Alternative Title:
BMC Public Health
Publisher's site:
http://dx.doi.org/10.1186/1471-2458-10-433
Personal Author:
Russell, Elizabeth C; Charalambous, Salome; Pemba, Lindiwe; Churchyard, Gavin J; Grant, Alison D; ... More +
Russell, Elizabeth C; Charalambous, Salome; Pemba, Lindiwe; Churchyard, Gavin J; Grant, Alison D; Fielding, Katherine; Less -
Description:
Background Antiretroviral therapy (ART) has dramatically reduced morbidity and mortality among people with HIV infection; however, mortality after the start of ART is high in resource-limited settings. We investigated risk factors for mortality among adults starting ART in a multi-clinic community programme in South Africa. Methods Cohort of adults starting ART at 27 clinics between February 2005 and June 2006, followed to 31st March 2007. Kaplan-Meier survival estimates were used to describe overall mortality. Shared frailty Cox regression was used to identify baseline risk factors for early mortality. Results Among 1350 participants (median age 35.5 years, 60% female, median CD4 count 83/μL [interquartile range (27 - 147)], median follow-up 13.4 months), there were 185 deaths, overall mortality rate 13/100 pyrs; for 0-3, 3-9 and >9 months from ART start mortality rates were 24, 13 and 6/100 pyrs respectively. 43% of the deaths were in the first 3 months of treatment. Risk factors for mortality in univariable analysis were baseline CD4 count, viral load, haemoglobin and body mass index, in multivariable analysis adjusting for age and gender, only CD4 count and haemoglobin remained independently associated with proportional hazards not being satisfied for haemoglobin. Adjusted hazard ratios (aHR) for participants with haemoglobin <8, 8.1-9.9, >11.9(f)/12.9 (m) g/mL were 4.99, 3.05 and 0.12 respectively comparing to 10-11.9 (f)/12.9 (m)g/mL in the first 3 months of ART. aHRs for CD4 counts were 0.40, 0.38 and 0.34 for 50-99, 100-200 and >200/μL comparing to <50/μL. Conclusions The high mortality rate in the first 3 months underlines the need for earlier HIV diagnosis so that ART can be initiated earlier. Low haemoglobin and low CD4 count are both strong predictors of mortality, and could be used to identify individuals at high risk who might benefit from intensive case management.
Subject:
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Adolescent
Adult
Aged
Antirheumatic Agents
Cohort Studies
Female
Hemoglobins
HIV Infections
Humans
Male
Middle Aged
Predictive Value Of Tests
Proportional Hazards Models
Research Article
Risk Factors
Survival Analysis

Source:
BMC Public Health. 2010; 10:433.;
Pubmed ID:
20653940
Pubmed Central ID:
PMC2919476
Document Type:
Journal Article;
Funding:
Medical Research Council/United Kingdom; U2GPS000811/PHS HHS/United States; G0700837/Medical Research Council/United Kingdom; AI51794/AI/NIAID NIH HHS/United States; PS024055/PS/NCHHSTP CDC HHS/United States; ... More +
Medical Research Council/United Kingdom; U2GPS000811/PHS HHS/United States; G0700837/Medical Research Council/United Kingdom; AI51794/AI/NIAID NIH HHS/United States; PS024055/PS/NCHHSTP CDC HHS/United States; SU062PS024055/PS/NCHHSTP CDC HHS/United States; AI069469/AI/NIAID NIH HHS/United States; Less -
Place as Subject:
South Africa;
Collection(s):
CDC Public Access
Emerging Infectious Diseases
Main Document Checksum:
[+]
urn:sha256:85022ba82a11aa4f984c9122f2e1fa64a181deee21c9422bd68eaa32b877f5fe
File Type:

Supporting Files

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