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. 2008 Apr 22:8:52.
doi: 10.1186/1471-2334-8-52.

Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania

Asgeir Johannessen  1 , Ezra Naman, Bernard J Ngowi, Leiv Sandvik, Mecky I Matee, Henry E Aglen, Svein G Gundersen, Johan N Bruun
Affiliations

Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania

Asgeir Johannessen et al. BMC Infect Dis. .

Abstract

Background: Studies of antiretroviral therapy (ART) programs in Africa have shown high initial mortality. Factors contributing to this high mortality are poorly described. The aim of the present study was to assess mortality and to identify predictors of mortality in HIV-infected patients starting ART in a rural hospital in Tanzania.

Methods: This was a cohort study of 320 treatment-naïve adults who started ART between October 2003 and November 2006. Reliable CD4 cell counts were not available, thus ART initiation was based on clinical criteria in accordance with WHO and Tanzanian guidelines. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.

Results: Patients were followed for a median of 10.9 months (IQR 2.9-19.5). Overall, 95 patients died, among whom 59 died within 3 months of starting ART. Estimated mortality was 19.2, 29.0 and 40.7% at 3, 12 and 36 months, respectively. Independent predictors of mortality were severe anemia (hemoglobin <8 g/dL; adjusted hazard ratio [AHR] 9.20; 95% CI 2.05-41.3), moderate anemia (hemoglobin 8-9.9 g/dL; AHR 7.50; 95% CI 1.77-31.9), thrombocytopenia (platelet count <150 x 109/L; AHR 2.30; 95% CI 1.33-3.99) and severe malnutrition (body mass index <16 kg/m2; AHR 2.12; 95% CI 1.06-4.24). Estimated one year mortality was 55.2% in patients with severe anemia, compared to 3.7% in patients without anemia (P < 0.001).

Conclusion: Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings.

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Figures

Figure 1
Figure 1
Profile of the study cohort, Haydom Lutheran Hospital, Tanzania (October 2003–November 2006).
Figure 2
Figure 2
Kaplan-Meier survival curves according to baseline hemoglobin. Normal: >12 g/dL (>13 g/dL for men); mild anemia: 10–11.9 g/dL (10–12.9 g/dL for men); moderate anemia: 8–9.9 g/dL; severe anemia: <8 g/dL.
Figure 3
Figure 3
Kaplan-Meier survival curves according to baseline body mass index.
See this image and copyright information in PMC

References

    1. Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, Costagliola D, d'Arminio MA, de WF, Reiss P, Lundgren JD, Justice AC, Staszewski S, Leport C, Hogg RS, Sabin CA, Gill MJ, Salzberger B, Sterne JA. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360:119–129. doi: 10.1016/S0140-6736(02)09411-4. - DOI - PubMed
    1. Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, d'Arminio MA, Yust I, Bruun JN, Phillips AN, Lundgren JD. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet. 1998;352:1725–1730. doi: 10.1016/S0140-6736(98)03201-2. - DOI - PubMed
    1. Ivers LC, Kendrick D, Doucette K. Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature. Clin Infect Dis. 2005;41:217–224. doi: 10.1086/431199. - DOI - PubMed
    1. WHO . Scaling up antiretroviral therapy in resource-limited settings Guidelines for a public health approach. Geneva, WHO; 2002. - PubMed
    1. WHO . Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach 2003 revision. Geneva, WHO; 2004. - PubMed

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