Excessive Early Mortality in the First Year of Treatment in HIV Type 1-Infected Patients Initiating Antiretroviral Therapy in Resource-Limited Settings

Abstract

The response to treatment and risk factors for early mortality following initiation of combination antiretrovirals(ARVs) in a cohort of African patients are described in a retrospective cohort design. Medical history, laboratory parameters, and mortality data were reviewed for patients initiating ARVs in 12 clinical centers in Mozambique, Tanzania, and Malawi. Among 3456 HIV-1-infected patients who received ARVs for more than 6 months, at baseline 72% had WHO clinical stages 3/4, 7% had a viral load 400 copies/ml, and 38% had a CD4 cell count >200/microl. One year later, 78% had undetectable virus loads and 79% had CD4 cell counts >200 cells/mm3. In the first year of HAART 260 deaths occurred (97 per 1000 person/years) with mortality peaking in the first 3 months. The highest mortality was observed in patients with low BMI, low hemoglobin levels, and CD4 values <200 cells/microl at baseline. Mortality rates following initiation of HAART are higher in patients in resource-limited areas, particularly in the first 90 days following treatment initiation.HAART initiated at higher CD4 cell count levels, especially among malnourished and/or anemic patients, will carry significant public health impact.

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

“…Our study population appears to be representative of the adult population on ART in Malawi, in that the demographic features and the clinical and immunological baseline indicators signifying advanced HIV disease were comparable to national data. 42 Baseline characteristics and overall oneyear virological and immunological outcomes are also comparable to other ART cohorts in sub-Saharan Africa, 25,27,43 supporting the external validity of our data for guidance of policy in ART scale-up programmes in the region.…”

Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda

“…Our findings show that treatment outcomes in this group of patients in western Uganda were quite positive with 88.9% of patients achieving virological suppression after six months and higher than in other ART studies in sub-Saharan Africa (Braitstein et al, 2006;Kaleebu et al, 2006;Marazzi et al, 2008;Weidle et al, 2006). An important finding was that a positive ART outcome was associated with female gender after controlling for baseline demographic variables that we measured.…”

Clinical and Immunological Characteristics in HIV-Infected Patients at the Treatment Initiation at the University Hospital of Parakou (Benin)

“…In this study, 34.02% of the patients were undernutrited. These outcomes are superimposable to the ones of Marazzi [9] who reported 34% as prevalence of undernutrition in HIV infected patients. Koné [10] reported a body mass index average of 17.2 ± 3.06 kg/m 2 , indicator of undernutrition.…”