1. Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating antiretroviral therapy in resource-limited settings.
- Author
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Marazzi MC, Liotta G, Germano P, Guidotti G, Altan AD, Ceffa S, Lio MM, Nielsen-Saines K, and Palombi L
- Subjects
- Adult, Anemia, Antiretroviral Therapy, Highly Active adverse effects, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes immunology, Cohort Studies, Developing Countries, Female, HIV Infections mortality, Humans, Malawi epidemiology, Male, Malnutrition, Mozambique epidemiology, Proportional Hazards Models, Retrospective Studies, Risk Factors, Tanzania epidemiology, Treatment Outcome, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV-1
- 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.
- Published
- 2008
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