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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda
Journal of Acquired Immune Deficiency Syndromes, Volume 58, No. 3, Year 2011
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Description
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/m 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. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Moore, David M.
United States, Atlanta
Centers for Disease Control and Prevention
Canada, Vancouver
British Columbia Centre for Excellence in Hiv-aids
Canada, Vancouver
The University of British Columbia
Yiannoutsos, Constantin Theodore
United States, Indianapolis
Indiana University School of Medicine
Musick, Beverly Sue
United States, Indianapolis
Indiana University School of Medicine
Tappero, Jordan W.
United States, Atlanta
Centers for Disease Control and Prevention
Degerman, Richard
United States, Atlanta
Centers for Disease Control and Prevention
Campbell, James D.
Uganda
Division of Hiv/aids Prevention
Were, Willy A.
United States, Atlanta
Centers for Disease Control and Prevention
Kaharuza, Frank M.
United States, Atlanta
Centers for Disease Control and Prevention
Alexander, Lorraine N.
United States, Atlanta
Centers for Disease Control and Prevention
Downing, Robert G.
United States, Atlanta
Centers for Disease Control and Prevention
Mermin, Jonathan H.
United States, Atlanta
Centers for Disease Control and Prevention
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Statistics
Citations: 45
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1097/QAI.0b013e3182303716
ISSN:
15254135
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Locations
Uganda
Participants Gender
Female