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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Late Presentation with HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial
Clinical Infectious Diseases, Volume 66, Year 2018
Notification
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Description
Background. Severely immunocompromised human immunodefciency virus (HIV)-infected individuals have high mortality shortly afer starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods. Te Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children =5 years of age with CD4 counts <100 cells/μL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identifed using Cox regression with backwards elimination (exit P >.1). Results. Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P <.04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P =.02). Of fve late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/μL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/μL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/μL), but low symptom burden and maintained fat mass. Te remaining groups had 4%-6% mortality. Conclusions. Clinical and laboratory features identifed groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. © 2018 World Health Organization.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC5850547/bin/cix1142_suppl_supplemental_data.docx
Authors & Co-Authors
Siika, Abraham Mosigisi
Kenya, Eldoret
Moi University
McCabe, Leanne
United Kingdom, London
Medical Research Council
Bwakura-Dangarembizi, Mutsa F.
Zimbabwe, Harare
University of Zimbabwe
Kityo, Cissy Mutuluuza
Uganda, Kampala
Joint Clinical Research Center Uganda
Mallewa, Jane E.
Malawi, Blantyre
Kamuzu University of Health Sciences
Berkley, James Alexander
Kenya, Nairobi
Kenya Medical Research Institute
Maitland, Kathryn M.
Kenya, Nairobi
Kenya Medical Research Institute
Griffiths, Anna L.
United Kingdom, London
Medical Research Council
Baleeta, Keith
Uganda, Gulu
Joint Clinical Research Centre
Mudzingwa, Shepherd
Zimbabwe, Harare
University of Zimbabwe
Abach, James
Uganda, Gulu
Joint Clinical Research Centre
Nathoo, Kusum Jackison
Zimbabwe, Harare
University of Zimbabwe
Thomason, Margaret J.
United Kingdom, London
Medical Research Council
Prendergast, Andrew J.
United Kingdom, London
Queen Mary University of London
Walker, Anne Sarah
United Kingdom, London
Medical Research Council
Gibb, Diana M.
United Kingdom, London
Medical Research Council
Mugyenyi, Peter N.
Unknown Affiliation
Musiime, Victor
Unknown Affiliation
Wavamunno, Priscilla
Unknown Affiliation
Nambi, Esther
Unknown Affiliation
Ocitti, Paul
Unknown Affiliation
Ndigendawani, Milly
Unknown Affiliation
Kemigisa, Mable
Unknown Affiliation
Acen, Juliet
Unknown Affiliation
Olebo, David Francis
Unknown Affiliation
Mpamize, Gordon
Unknown Affiliation
Amone, Alexander
Unknown Affiliation
Okweny, David
Unknown Affiliation
Mbonye, Andrew
Unknown Affiliation
Nambaziira, Florence
Unknown Affiliation
Rweyora, Angela K.
Unknown Affiliation
Kangah, Mary Goretti
Unknown Affiliation
Kabaswahili, V.
Unknown Affiliation
Abongomera, George
Unknown Affiliation
Omongin, Joseph
Unknown Affiliation
Aciro, Irene Claren
Unknown Affiliation
Philliam, Aleti
Unknown Affiliation
Arach, Beatrice
Unknown Affiliation
Ocung, Emmanuel
Unknown Affiliation
Amone, Geoffrey
Unknown Affiliation
Miles, Peter
Unknown Affiliation
Adong, Claudia
Unknown Affiliation
Tumsuiime, Constance
Unknown Affiliation
Kidega, Patrick
Unknown Affiliation
Otto, Benjamin
Unknown Affiliation
Apio, Florence
Unknown Affiliation
Mukuye, Andrew
Unknown Affiliation
Abwola, Mary C.
Unknown Affiliation
Ssennono, Fred
Unknown Affiliation
Baliruno, David
Unknown Affiliation
Tuhirwe, Stephen
Unknown Affiliation
Namisi, Ronald
Unknown Affiliation
Kigongo, Fredrick
Unknown Affiliation
Kikyonkyo, Dickson
Unknown Affiliation
Mushahara, Furaha
Unknown Affiliation
Tusiime, Julian
Unknown Affiliation
Musiime, Alex V.
Unknown Affiliation
Nankya, Agnes
Unknown Affiliation
Atwongyeire, Dickens
Unknown Affiliation
Sirikye, Sowal
Unknown Affiliation
Mula, S.
Unknown Affiliation
Noowe, Nelson
Unknown Affiliation
Lugemwa, Abbas
Unknown Affiliation
Kasozi, Miriam
Unknown Affiliation
Mwebe, Sandra Z.
Unknown Affiliation
Atwine, Lorna
Unknown Affiliation
Senkindu, Tapson
Unknown Affiliation
Natuhurira, T.
Unknown Affiliation
Katemba, Chrispus
Unknown Affiliation
Ninsiima, Emily
Unknown Affiliation
Acaku, Moses
Unknown Affiliation
Kyomuhangi, Joy
Unknown Affiliation
Ankunda, Rogers
Unknown Affiliation
Tukwasibwe, Deogratiuos
Unknown Affiliation
Ayesiga, Lillian
Unknown Affiliation
Hakim, James Gita
Unknown Affiliation
Reid, Andrew
Unknown Affiliation
Chidziva, Ennie
Unknown Affiliation
Mhute, Tawanda
Unknown Affiliation
Tinago, Gloria C.
Unknown Affiliation
Bhiri, Joyline
Unknown Affiliation
Phiri, Misheck Nkalo
Unknown Affiliation
Steamer, John
Unknown Affiliation
Nhema, Ruth
Unknown Affiliation
Warambwa, Colin
Unknown Affiliation
Musoro, Godfrey
Unknown Affiliation
Mutsai, Shirley
Unknown Affiliation
Nemasango, Beauty
Unknown Affiliation
Moyo, Columbus
Unknown Affiliation
Chitongo, Stuart
Unknown Affiliation
Rashirai, Kennias M.
Unknown Affiliation
Vhembo, Sydney
Unknown Affiliation
Mlambo, Brian
Unknown Affiliation
Nkomani, Sanele
Unknown Affiliation
Ndemera, Buxton
Unknown Affiliation
Willard, Marko
Unknown Affiliation
Berejena, Chipo
Unknown Affiliation
Musodza, Yeukai
Unknown Affiliation
Matiza, Patience
Unknown Affiliation
Mudenge, Boniface
Unknown Affiliation
Etyang, Anthony O.
Unknown Affiliation
Agutu, Clara A.
Unknown Affiliation
Njuguna, Patricia
Unknown Affiliation
Mwaringa, Shalton Lwambi
Unknown Affiliation
Etyang, Timothy Juma
Unknown Affiliation
Awuondo, Ken O.
Unknown Affiliation
Shangala, Jimmy
Unknown Affiliation
Mwarumba, Salim
Unknown Affiliation
Mwambingu, Gabriel
Unknown Affiliation
Mwanzu, Alfred
Unknown Affiliation
Shikuku, Joyce
Unknown Affiliation
Njogu, Anne
Unknown Affiliation
Wools-Kaloustian, Kara K.
Unknown Affiliation
Nyandiko, Winstone Mokaya
Unknown Affiliation
Cheruiyot, Priscilla Chepkorir
Unknown Affiliation
Sudoi, Allan
Unknown Affiliation
Wachira, Simon
Unknown Affiliation
Karoney, Mercy Jelagat
Unknown Affiliation
Mokaya, Martha Mokeira Bisieri
Unknown Affiliation
Mboya, Chris Sande
Unknown Affiliation
Injera, Wilfred Emonyi
Unknown Affiliation
Cherutich, Salinah
Unknown Affiliation
Kutto, Irene
Unknown Affiliation
Kaunda, Symon
Unknown Affiliation
van Oosterhout, Joep J.G.
Unknown Affiliation
O'Hare, Bernadette A.M.
Unknown Affiliation
Heydermann, Robert
Unknown Affiliation
Dzabala, Nettie
Unknown Affiliation
Kelly, Christine M.
Unknown Affiliation
Denis, Brigitte B.
Unknown Affiliation
Selemani, George
Unknown Affiliation
Nyondo-Mipando, Linda Alinane
Unknown Affiliation
Banda, Peter K.
Unknown Affiliation
Msuku, Harrison
Unknown Affiliation
Masesa, Clemens
Unknown Affiliation
Mwalukomo, Thandie S.
Unknown Affiliation
Makhaza, Lumbani
Unknown Affiliation
Sheha, Irene
Unknown Affiliation
Bwanali, Joseph
Unknown Affiliation
Pett, Sarah Lilian
Unknown Affiliation
Szubert, Alexander J.
Unknown Affiliation
Wilkes, Helen C.
Unknown Affiliation
Rajapakse, Chathurika
Unknown Affiliation
Spyer, Moira J.
Unknown Affiliation
Klein, Nigel J.
Unknown Affiliation
Van-Looy, Nadine
Unknown Affiliation
Little, Emma
Unknown Affiliation
Fairbrother, Keith
Unknown Affiliation
Cowan, Frances Mary
Unknown Affiliation
Seeley, Janet A.
Unknown Affiliation
Bernays, Sarah
Unknown Affiliation
Kawuma, Rachel
Unknown Affiliation
Mupambireyi, Zivai
Unknown Affiliation
Kyomuhendo, Flavia
Unknown Affiliation
Nakalanzi, Sarah
Unknown Affiliation
Peshu, Judy
Unknown Affiliation
Chabuka, John
Unknown Affiliation
Mkandawire, Nkhafwire
Unknown Affiliation
Weller, Ian V.D.
Unknown Affiliation
Malianga, E.
Unknown Affiliation
Mwansambo, Charles C.V.
Unknown Affiliation
Miiro, F.
Unknown Affiliation
Elyanu, Peter J.
Unknown Affiliation
Bukusi, Elizabeth Anne
Unknown Affiliation
Katabira, Elly Tebasoboke
Unknown Affiliation
Mugurungi, Owen M.
Unknown Affiliation
Peto, Timothy E.A.
Unknown Affiliation
Musoke, Philippa Martha
Unknown Affiliation
Matenga, Jonathan Arthur
Unknown Affiliation
Phiri, Sam John Peter
Unknown Affiliation
Lyall, Hermione
Unknown Affiliation
Johnston, Victoria J.
Unknown Affiliation
Fitzgerald, Felicity C.
Unknown Affiliation
Post, Frank A.
Unknown Affiliation
Ssali, Francis N.
Unknown Affiliation
Arenas-Pinto, Alejandro
Unknown Affiliation
Turkova, Anna
Unknown Affiliation
Bamford, A. R.J.
Unknown Affiliation
Statistics
Citations: 28
Authors: 178
Affiliations: 8
Identifiers
Doi:
10.1093/cid/cix1142
ISSN:
10584838
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Kenya
Malawi
Uganda
Zimbabwe