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November 10, 2005AIDS

Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design

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Authors

SLStephen D LawnLondon School of Hygiene & Tropical MedicineLMLandon MyerUniversity of Cape TownCOCatherine OrrellSouth African Medical Research Council

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Implication

Prospective cohort study finds high pre-treatment mortality among adults awaiting antiretroviral therapy, highlighting the critical need to expedite treatment initiation.

Key Points

  • To evaluate rates, risk factors, and causes of mortality among HIV-infected adults enrolling in a community-based antiretroviral therapy programme before and after starting treatment.
  • Prospective cohort study tracking 712 treatment-naive adults (median baseline CD4 count 94 cells/µL) enrolling in a community-based antiretroviral therapy (ART) service in Cape Town, South Africa, between September 2002 and March 2005.
  • Ascertained all in-programme deaths pre-treatment and post-treatment initiation across 563 person-years of observation, analyzing risk factors using multivariate models.
  • Mortality fell from a pre-treatment rate of 35.6 deaths per 100 person-years (95% CI, 23.0–55.1) to 2.5 deaths per 100 person-years (95% CI, 0.9–6.6) at 1 year among patients receiving ART.
  • Within 90 days of enrollment, 66% (29/44) of deaths occurred among patients awaiting ART; independent predictors of death were baseline CD4 count and WHO clinical stage, with stage 4 conferring the greatest risk.
  • Leading causes of death were wasting syndrome, tuberculosis, acute bacterial infections, malignancy, and immune reconstitution disease.

Cite This Study

Lawn et al. (2005) studied this question.

synapsesocial.com/papers/6a1a7bca353de69e89b88f96https://doi.org/10.1097/01.aids.0000194802.89540.e1
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