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Multicenter Study
. 2009 Aug 15;51(5):615-23.
doi: 10.1097/QAI.0b013e3181a44f0a.

Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean

Suely H Tuboi  1 , Mauro Schechter, Catherine C McGowan, Carina Cesar, Alejandro Krolewiecki, Pedro Cahn, Marcelo Wolff, Jean W Pape, Denis Padgett, Juan Sierra Madero, Eduardo Gotuzzo, Daniel R Masys, Bryan E Shepherd
Affiliations
Multicenter Study

Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean

Suely H Tuboi et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Although nearly 2 million people live with HIV in Latin America and the Caribbean, mortality rates after initiation of highly active antiretroviral therapy (HAART) have not been well described.

Methods: Five thousand one hundred fifty-two HIV-infected, antiretroviral-naive adults from clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru starting HAART during 1996-2007 were included. First-year mortality rates and their association with demographics, regimen, baseline CD4, and clinical stage were assessed.

Results: Overall 1-year mortality rate was 8.3% [95% confidence interval (CI): 7.6% to 9.1%], although variable across sites: 2.6%, 3.7%, 6.0%, 13.0%, 10.8%, 3.5%, and 9.8% for clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, respectively. Eighty percent of deaths occurred within the first 6 months. Median baseline CD4 was 107 cells per milliliter, ranging from 79 (Peru) to 163 (Argentina). Mortality estimates adjusting for CD4 were similar across sites (1.1%-2.8% for CD4 = 200), except for Haiti, 7.5%, and Honduras, 7.0%. Death was associated with lower CD4 [adjusted hazard ratio for CD4 = 200 vs. CD4 = 50 was 0.58; 95% CI: 0.40 to 0.85] and clinical AIDS (hazard ratio = 3.1; 95% CI: 2.1 to 4.5).

Conclusions: Mortality rates were similar to those reported elsewhere for resource-limited settings. Disease stage at HAART initiation, treatment eligibility criteria, program age, and background mortality rates may explain some variability in prognosis between sites.

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Figures

Figure 1
Figure 1
Crude mortality rates during the first year after HAART initiation.
Figure 2
Figure 2
Probability and 95% confidence intervals for death at one year (left panel), and estimated for subjects in each cohort initiating HAART with CD4=50 (middle panel), and CD4=200 (right panel). Study sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru are represented by A, B, C, Ha, Ho, M, and P, respectively.
Figure 3
Figure 3
Crude rates of loss to follow-up or death during the first year after HAART initiation.
See this image and copyright information in PMC

References

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