Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study (original) (raw)
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Advances in Infectious Diseases, 2013
Background: In sub Saharan Africa, small size surveys have demonstrated early high mortality among infected patients on antiretroviral therapies (ART). Few studies have been conducted in large cohorts of HIV-patients in public health care system in West Africa. Objectives: Our study aims to determine mortality rate and its predictors in a cohort of patients on ART in a public daycare hospital in Burkina Faso. Methods: We have carried out a retrospective cohort study. All HIV-infected patients on ART between January 1st 2008 and December 31st 2011 were included in the study. Survival probability was estimated by the Kaplan-Meier method. Cox regression analysis was used to identify associated factors to mortality. Results: A total of 2243 HIV-infected patients were included in the study. During the follow-up, 218 patients representing 9.7% were lost. About 104 patients representing 4.6% were transferred and 1691 representing 75.4% were still in the therapeutic cohort. There were 230 death cases for a total of 4282 persons-years, (5.4 deaths for 100 persons-years; 95% CI: 4.8-6.3). The survival probabilities after 6 months, 1 year and 2 years were 92.6%, 91% and 88.9% respectively. For the multivariate analysis, the following factors were independently associated to death: male gender, BMI < 18.5 kg/m 2 , WHO stage 3 and 4, HIV-2, T-CD4 lymphocytes < 200/µl, haemoglobin rate < 8 g/dl and creatinine clearance < 60 ml/m 2. Conclusions: Our study provides for the first time mortality rates and its predictors among HIV-patients on antiretroviral treatment in a large cohort in public health sector in Burkina Faso. It highlights the importance of early HIV screening to limit ART initiation at advanced HIV infection stages.
Clinical Infectious Diseases
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% wer...
PLOS ONE
Introduction Despite increased treatment availability, HIV-infected individuals continue to start antiretroviral therapy (ART) late in disease progression, increasing early mortality risk. Materials and methods Nested prospective cohort study within a randomized clinical trial of adult patients initiating ART at clinics in urban Nairobi and rural Maseno, Kenya, between 2013-2014. We estimated mortality incidence rates following ART initiation and used Cox proportional hazards regression to identify predictors of mortality within 12 months of ART initiation. Analyses were stratified by clinic site to examine differences in mortality correlates and risk by location. Results Among 811 participants initiated on ART, the mortality incidence rate within a year of initiating ART was 7.44 per 100 person-years (95% CI 5.71, 9.69). Among 207 Maseno and 612 Nairobi participants initiated on ART, the mortality incidence rates (per 100 person-years) were 12.78 (95% CI 8.49, 19.23) and 5.72 (95% CI 4.05, 8.09). Maseno had a 2.20-fold greater risk of mortality than Nairobi (95% CI 1.29, 3.76; P = 0.004). This association remained [adjusted hazard ratio (HR) = 2.09 (95% CI 1.17, 3.74); P = 0.013] when adjusting for age, gender, education, pre-treatment drug resistance (PDR), and CD4 count, but not when adjusting for BMI. In unadjusted analyses, other predictors (P<0.
2016
Development of HAART in the mid-1990's and its continued scale up has revolutionized the treatment of HIV-infected patients and led to remarkable reductions in HIV associated morbidity and mortality. However, recent studies have suggested a higher risk for early mortality in adults receiving ART in low-income countries as compared to those in high-income countries. There is dearth of data from developing countries where the burden of disease is high. The objective is to describe the burden and correlation between early vs. delayed mortality associated with HIV/AIDS in resource poor settings using data from Tanzania in East Africa. We performed a cross-sectional evaluation of routinely collected program data for 991 HIV-positive deceased adult patients who were placed on ART treatment, and died between January 1, 2007 and December 31, 2012. Data used were abstracted from records of patients who were treated at six health facilities in the Lake-zone Region of Tanzania in the timef...
AIDS Research and Treatment, 2012
We examined mortality rates and its predictors from a five years retrospective cohort data of HIV/AIDs patients attending care and treatment clinic in Biharamulo Tanzania. Cox regression analysis was used to identify predictors of mortality. Of the 546 patient records retrieved, the mean age was 37 years with median CD4 count of 156 cells. The mortality rate was 4.32/100 person years at risk with males having three times higher mortality compared to females. Starting Antiretroviral treatment with advanced disease state, body weight below 45 kegs, WHO stage 4 disease, and CD4 cells below 50 were main predictors of mortality. Promoting early voluntary counselling and testing should be given a priority to facilitate timely start of treatment.
AIDS, 2015
Objectives: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme. Design: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013. Methods: A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results. Results: Median follow-up time was 37 months (interquartile range 11-75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49-12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98-1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002-2012. Tenofovir was associated with lower mortality than stavudine and zidovudine. Conclusion: The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4 þ cell count less than 100 cells/ml, older age and being male were associated with higher odds of mortality.
The lancet HIV, 2015
Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resource limited settings is a critical measure of the effectiveness and comparative effectiveness of the global public health response. Unknown outcomes due to high loss to follow-up (LTFU) preclude accurate accounting of deaths and limit our understanding of effectiveness. We evaluated in HIV-infected adults on ART in 14 clinics in five settings in Kenya, Uganda and Tanzania using a sampling-based approach in which we intensively traced a random sample of lost patients (> 90 days late for last scheduled visit) and incorporated their vital status outcomes into analyses of the entire clinic population through probability-weighted survival analyses. We followed 34,277 adults on ART from Mbarara and Kampala, Uganda; Eldoret and Kisumu, Kenya; and Morogoro, Tanzania. The median age was 35 years, 34% were men, and median pre-therapy CD4 count was 154 cells/μl. Overall 5,780 (17%) were LTFU, 99...