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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Hyponatremia, hypochloremia, and hypoalbuminemia predict an increased risk of mortality during the first year of antiretroviral therapy among HIV-infected Zambian and Kenyan women
AIDS Research and Human Retroviruses, Volume 27, No. 11, Year 2011
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Description
Early mortality rates after initiating antiretroviral therapy (ART) are high in sub-Saharan Africa. We examined whether serum chemistries at ART initiation predicted mortality among HIV-infected women. From May 2005 to January 2007, we enrolled women initiating ART in a prospective cohort study in Zambia and Kenya. We used Cox proportional hazards models to identify risk factors associated with mortality. Among 661 HIV-infected women, 53 (8%) died during the first year of ART, and tuberculosis was the most common cause of death (32%). Women were more likely to die if they were both hyponatremic (sodium <135mmol/liter) and hypochloremic (chloride <95mmol/liter) (37% vs. 6%) or hypoalbuminemic (albumin <34g/liter, 13% vs. 4%) when initiating ART. A body mass index <18kg/m2 [adjusted hazard ratio (aHR) 5.3, 95% confidence interval (CI) 2.6-10.6] and hyponatremia with hypochloremia (aHR 4.5, 95% CI 2.2-9.4) were associated with 1-year mortality after adjusting for country, CD4 cell count, WHO clinical stage, hemoglobin, and albumin. Among women with a CD4 cell count >50 cells/μl, hypoalbuminemia was also a significant predictor of mortality (aHR=3.7, 95% CI 1.4-9.8). Baseline hyponatremia with hypochloremia and hypoalbuminemia predicted mortality in the first year of initiating ART, and these abnormalities might reflect opportunistic infections (e.g., tuberculosis) or advanced HIV disease. Assessment of serum sodium, chloride, and albumin can identify HIV-infected patients at highest risk for mortality who may benefit from more intensive medical management during the first year of ART. © 2011, Mary Ann Liebert, Inc.
Authors & Co-Authors
Dao, Christine N.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Peters, Philip James
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Kiarie, James Njogu
Kenya, Nairobi
Kenyatta National Hospital
Zulu, Isaac S.
Zambia, Lusaka
Cdc-zambia
Muiruri, Peter N.
Kenya, Nairobi
Kenyatta National Hospital
Ong'Ech, John Odero
Kenya, Nairobi
Kenyatta National Hospital
Mutsotso, Winfred
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Potter, Dara
Zambia, Lusaka
Cdc-zambia
Njobvu, Lungowe
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Stringer, Jeffrey S.A.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Borkowf, Craig B.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Bolu, Omotayo O.
United States, Atlanta
Centers for Disease Control and Prevention
Weidle, Paul J.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Statistics
Citations: 40
Authors: 13
Affiliations: 7
Identifiers
Doi:
10.1089/aid.2010.0345
ISSN:
08892229
e-ISSN:
19318405
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Kenya
Zambia
Participants Gender
Female