Profile of cause of death assigned to adults on antiretroviral therapy in Soweto

Karstaedt, Alan

doi:10.7196/samj.5369

Cited by 8 publications

(11 citation statements)

References 12 publications

(20 reference statements)

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“…TB caused death in 14% of patients and was the main cause of death across the study period. This is consistent with the findings of others, who have shown the major contribution of TB to death in the African HIV population [24][25][26][27].This finding highlights the need to strengthen HIV-TB collaborative services in settings such as Zimbabwe. There have been encouraging changes in the field of TB management in SSA which are likely to improve the clinical outcomes among HIV-TB co-infected people.…”

Section: Plos Onesupporting

confidence: 92%

Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe

Chimbetete

Shamu²,

Roelens

et al. 2020

PLoS ONE

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Background We report trends in mortality patterns and causes among HIV positive patients, who initiated antiretroviral therapy (ART), at an urban clinic in Harare, Zimbabwe. Methods A retrospective cohort study was conducted in which routinely collected data for patients enrolled and followed up between February 2004 and December 2017 were assessed. Patients follow up was from the day of the treatment initiation until exit by death, transfer out or loss to follow up. Two doctors categorized causes of death (COD) as tuberculosis (TB), communicable AIDS, non-communicable diseases (NCDs), malignancies, others and unknown. We used competing risk survival analysis, first to estimate all-causes and causespecific mortality rates over time, and then to assess risk factors of different causes of death. Results A total of 4 868 patients were followed up for 27 527 person years (PY). Among the 506 patients who died, COD was unknown for 76 patients (15%) and common COD were TB (n = 71, 14%), Malignancies (n = 54, 10.7%) Meningitis (n = 39, 7.7%) and NCDs (n = 60, 11.9%). 49.4% of the deaths were within the first year of starting ART. Median age at death was 36 years (IQR:19-46). There was a near threefold increase in proportion of deaths due to NCDs and malignancies over the period of follow up. Low baseline CD4 cell count and WHO stages 3 & 4 were significant risk factors for all-cause mortality. Conclusions TB remains the leading cause of death among HIV infected people. Deaths due to NCDs and malignancies increased over time. ART facilities need to incorporate management of NCDs including cancer as part of comprehensive care of PLHIV to reduce mortality.

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Section: Plos Onesupporting

confidence: 92%

Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe

Chimbetete

Shamu²,

Roelens

et al. 2020

PLoS ONE

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“…Deaths from ARV-related toxicity accounted for a significant number of deaths in SSC. 14,15,28,29 Pooled non-AIDS COD prevalence estimates in HIC was 54.1% (95% CI, 46.1-62.0), in DC 28.1% (95% CI, 16.4-41.5), and in SSC 18.5 (95% CI, 13.8-23.7) ( Figure 3). As noted, Q statistics and I 2 indicated heterogeneity of results across the categories (Q 2 ¼ 53.6, p < .001, I 2 ¼ 98.6).…”

Section: Resultsmentioning

confidence: 99%

“…37 In many circumstances, particularly among PLWH, there is more than one cause that leads to a person's death. 14 Identifying the leading cause, especially with limited information, can be very challenging and in some cases even impossible. 38,39 Combination of the results of studies with various methodologies (retrospective and prospective studies) and quality (standard classification vs. unidentified classification method) have increased the statistical power of our analysis and may provide more information on the distribution of non-AIDS COD among PLWH; however, it can also introduce bias as some of these studies may suffer from misclassification.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis

et al. 2016

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The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise. The objective of this study was to provide information about the global prevalence and distribution of non-AIDS causes of death in the last ten years among people living with HIV receiving antiretroviral therapy, by income levels of countries. We used broad search terms in Google Scholar, PubMed, and EMBASE to identify all studies that investigated the cause of death among people living with HIV receiving antiretroviral therapy, published after January 1, 2005. References were also identified from review articles and reference lists. Inclusion criteria were English language, the study's end date was after 2005, all patients were HIV-positive, at least two-thirds of the patients were receiving antiretroviral therapy, at least one patient died of non-AIDS causes of death. Titles, abstracts, and articles were reviewed by at least two independent readers. Of 2951 titles identified in our original search, 151 articles were selected for further screening. We identified 19 studies meeting our full criteria, with patients from 55 different nations. Pooled non-AIDS causes of death prevalence estimates in high-income countries were 53.0% (95% confidence interval, 43.6-62.3), in developing countries 34.0% (95% confidence interval, 20.3-49.1), and in sub-Saharan countries 18.5% (95% confidence interval, 13.8-23.7). Statistically significant variation was noted within and between categories. Our findings show that a significant number of people living with HIV across the world die from cardiovascular disease, non-AIDS malignancies, and liver disease. There is a global need for further scrutiny in all regions to improve preventive measures and early detection according to distinct causes of death patterns.

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“…The prevalence of incident antigenaemia among patients with a CD4 count < 100 cells/μl in this study was lower than the prevalence described in other African study populations , which directly impacts on potential cost‐effectiveness. The lower prevalence may be related to the study being conducted in a generally well out‐patient population or the impact of earlier HIV diagnosis and ART initiation on the incidence of cryptococcal disease in this population . Men were also significantly more likely to be diagnosed with cryptococcal antigenaemia.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of screening and treatment of cryptococcal antigenaemia among HIV‐infected persons in Soweto, South Africa

et al. 2015

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Profile of cause of death assigned to adults on antiretroviral therapy in Soweto

Abstract: Early mortality on antiretroviral therapy (ART) in low-income countries is substantially higher than in high-income countries.

Cited by 8 publications

References 12 publications

Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe

Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe

Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis

Evaluation of screening and treatment of cryptococcal antigenaemia among HIV‐infected persons in Soweto, South Africa

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