Determinants of Early and Late Mortality Among HIV-Infected Individuals Receiving Home-Based Antiretroviral Therapy in Rural Uganda
BACKGROUNDUp 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. METHODSWe examined data from...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2011-11, Vol.58 (3), p.289-296 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
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| creator | Moore, David M Yiannoutsos, Constantin T Musick, Beverly S Tappero, Jordan Degerman, Richard Campbell, James Were, Willy Kaharuza, Frank Alexander, Lorraine N Downing, Robert Mermin, Jonathan |
| description | BACKGROUNDUp 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.
METHODSWe 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.
RESULTSA 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 |
| doi_str_mv | 10.1097/QAI.0b013e3182303716 |
| format | Article |
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METHODSWe 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.
RESULTSA 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.
CONCLUSIONPotentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0b013e3182303716</identifier><identifier>PMID: 21857358</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; AIDS/HIV ; Anti-Retroviral Agents - administration & dosage ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active - methods ; Biological and medical sciences ; Drug therapy ; Female ; Fundamental and applied biological sciences. Psychology ; HIV Infections - drug therapy ; HIV Infections - mortality ; Human viral diseases ; Humans ; Indexing in process ; Infectious diseases ; Male ; Medical diagnosis ; Medical sciences ; Microbiology ; Middle Aged ; Miscellaneous ; Mortality ; Risk Factors ; Rural Population ; Survival Analysis ; Tuberculosis ; Uganda ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Virology ; Young Adult</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2011-11, Vol.58 (3), p.289-296</ispartof><rights>2011 Lippincott Williams & Wilkins, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Nov 1, 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5456-80e04952883af72af747acb57be4a824330f07add66dcdfbb60e9be285d5f5c33</citedby><cites>FETCH-LOGICAL-c5456-80e04952883af72af747acb57be4a824330f07add66dcdfbb60e9be285d5f5c33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24704841$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21857358$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moore, David M</creatorcontrib><creatorcontrib>Yiannoutsos, Constantin T</creatorcontrib><creatorcontrib>Musick, Beverly S</creatorcontrib><creatorcontrib>Tappero, Jordan</creatorcontrib><creatorcontrib>Degerman, Richard</creatorcontrib><creatorcontrib>Campbell, James</creatorcontrib><creatorcontrib>Were, Willy</creatorcontrib><creatorcontrib>Kaharuza, Frank</creatorcontrib><creatorcontrib>Alexander, Lorraine N</creatorcontrib><creatorcontrib>Downing, Robert</creatorcontrib><creatorcontrib>Mermin, Jonathan</creatorcontrib><title>Determinants of Early and Late Mortality Among HIV-Infected Individuals Receiving Home-Based Antiretroviral Therapy in Rural Uganda</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>BACKGROUNDUp 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.
METHODSWe 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.
RESULTSA 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.
CONCLUSIONPotentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.</description><subject>Adult</subject><subject>AIDS/HIV</subject><subject>Anti-Retroviral Agents - administration & dosage</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active - methods</subject><subject>Biological and medical sciences</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - mortality</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Indexing in process</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Microbiology</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Mortality</subject><subject>Risk Factors</subject><subject>Rural Population</subject><subject>Survival Analysis</subject><subject>Tuberculosis</subject><subject>Uganda</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Virology</subject><subject>Young Adult</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEomXhHyBkISFOKXZsx84FaSmFrrQIUbVcLceZdF0Se7GdrfbMH8erXQr0AAfLX8-8nvG8RfGc4BOCG_Hmy3xxgltMKFAiK4qpIPWD4pg0jJVCSvYwr3nFS0YoPyqexHiDMakZax4XRxWRXFAuj4sf7yFBGK3TLkXke3Smw7BF2nVoqROgTz4kPdi0RfPRu2t0vvhaLlwPJkGHFq6zG9tNeojoAgzkzQ7xI5TvdMzA3CUbIAW_sUEP6HIFQa-3yDp0Me0Orq7zQ_pp8ajPEvDsMM-Kqw9nl6fn5fLzx8XpfFkaznhdSgyYNbySkupeVHkwoU3LRQtMy4pRinssdNfVdWe6vm1rDE0LleQd77mhdFa83euup3aEzoBLOQm1DnbUYau8turvG2dX6tpvFBWCES6zwOuDQPDfJ4hJjTYaGAbtwE9RNYQQTmtM_09i3tRVLieTL--RN34KLv9DhnJTmRR1htgeMsHHGKC_S5pgtXODym5Q992Qw178WfBd0K_2Z-DVAdDR6KEP2hkbf3NMYCazgWaF3HO3fsh2id-G6RaCWoEe0urfOfwEEF3Q3A</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Moore, David M</creator><creator>Yiannoutsos, Constantin T</creator><creator>Musick, Beverly S</creator><creator>Tappero, Jordan</creator><creator>Degerman, Richard</creator><creator>Campbell, James</creator><creator>Were, Willy</creator><creator>Kaharuza, Frank</creator><creator>Alexander, Lorraine N</creator><creator>Downing, Robert</creator><creator>Mermin, Jonathan</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20111101</creationdate><title>Determinants of Early and Late Mortality Among HIV-Infected Individuals Receiving Home-Based Antiretroviral Therapy in Rural Uganda</title><author>Moore, David M ; Yiannoutsos, Constantin T ; Musick, Beverly S ; Tappero, Jordan ; Degerman, Richard ; Campbell, James ; Were, Willy ; Kaharuza, Frank ; Alexander, Lorraine N ; Downing, Robert ; Mermin, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5456-80e04952883af72af747acb57be4a824330f07add66dcdfbb60e9be285d5f5c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>AIDS/HIV</topic><topic>Anti-Retroviral Agents - administration & dosage</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral Therapy, Highly Active - methods</topic><topic>Biological and medical sciences</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - mortality</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Indexing in process</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Microbiology</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Mortality</topic><topic>Risk Factors</topic><topic>Rural Population</topic><topic>Survival Analysis</topic><topic>Tuberculosis</topic><topic>Uganda</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>Virology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, David M</creatorcontrib><creatorcontrib>Yiannoutsos, Constantin T</creatorcontrib><creatorcontrib>Musick, Beverly S</creatorcontrib><creatorcontrib>Tappero, Jordan</creatorcontrib><creatorcontrib>Degerman, Richard</creatorcontrib><creatorcontrib>Campbell, James</creatorcontrib><creatorcontrib>Were, Willy</creatorcontrib><creatorcontrib>Kaharuza, Frank</creatorcontrib><creatorcontrib>Alexander, Lorraine N</creatorcontrib><creatorcontrib>Downing, Robert</creatorcontrib><creatorcontrib>Mermin, Jonathan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, David M</au><au>Yiannoutsos, Constantin T</au><au>Musick, Beverly S</au><au>Tappero, Jordan</au><au>Degerman, Richard</au><au>Campbell, James</au><au>Were, Willy</au><au>Kaharuza, Frank</au><au>Alexander, Lorraine N</au><au>Downing, Robert</au><au>Mermin, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of Early and Late Mortality Among HIV-Infected Individuals Receiving Home-Based Antiretroviral Therapy in Rural Uganda</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>58</volume><issue>3</issue><spage>289</spage><epage>296</epage><pages>289-296</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><coden>JDSRET</coden><abstract>BACKGROUNDUp 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.
METHODSWe 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.
RESULTSA 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.
CONCLUSIONPotentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>21857358</pmid><doi>10.1097/QAI.0b013e3182303716</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult AIDS/HIV Anti-Retroviral Agents - administration & dosage Antiretroviral drugs Antiretroviral Therapy, Highly Active - methods Biological and medical sciences Drug therapy Female Fundamental and applied biological sciences. Psychology HIV Infections - drug therapy HIV Infections - mortality Human viral diseases Humans Indexing in process Infectious diseases Male Medical diagnosis Medical sciences Microbiology Middle Aged Miscellaneous Mortality Risk Factors Rural Population Survival Analysis Tuberculosis Uganda Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Virology Young Adult |
| title | Determinants of Early and Late Mortality Among HIV-Infected Individuals Receiving Home-Based Antiretroviral Therapy in Rural Uganda |
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