Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa

Objective. To identify predictors of mortality in patients initiating antiretroviral therapy (ART) in Durban, South Africa. Design. We conducted a retrospective cohort study analysing data on patients who presented to McCord Hospital, Durban, and started ART between 1 January 1999 and 29 February 2004. We performed univariate and multivariate analysis and constructed Kaplan-Meier curves to assess predictors. Results. Three hundred and nine patients were included. Forty-nine (16%) had died by the conclusion of the study. In univariate analysis, the strongest predictors of mortality were a CD4 cell count <50/μl (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.96 - 7.14), a haemoglobin concentration ≤8 g/dl (HR 1.23, 95% CI 1.08 - 1.40), a history of oral candidiasis (HR 3.17, 95% CI 1.70 - 5.87) and a history of cryptococcal meningitis (HR 2.76, 95% CI 1.80 - 19.2). A CD4 cell count <50/μl (HR 3.08, 95% CI 1.54 - 5.88) and a history of oral candidiasis (HR 2.58, 95% CI 1.37 - 4.88) remained significant in multivariate analysis. A history of tuberculosis was not a significant predictor of mortality. Conclusions. Simple clinical and laboratory data independently predict mortality and allow for risk stratification in patients initiating ART in South Africa. Interventions enabling patients to be identified before they develop these clinical markers and earlier initiation of ART will help to ensure maximum benefits of therapy.