Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Dec;88 Suppl 2(Suppl_2):i33-43.
doi: 10.1136/sextrans-2012-050658.

Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy

Constantin Theodore Yiannoutsos  1 , Leigh Francis Johnson, Andrew Boulle, Beverly Sue Musick, Thomas Gsponer, Eric Balestre, Matthew Law, Bryan E Shepherd, Matthias Egger; International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration
Affiliations
Free PMC article

Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy

Constantin Theodore Yiannoutsos et al. Sex Transm Infect. 2012 Dec.
Free PMC article

Abstract

Objective: To provide estimates of mortality among HIV-infected patients starting combination antiretroviral therapy.

Methods: We report on the death rates from 122 925 adult HIV-infected patients aged 15 years or older from East, Southern and West Africa, Asia Pacific and Latin America. We use two methods to adjust for biases in mortality estimation resulting from loss from follow-up, based on double-sampling methods applied to patient outreach (Kenya) and linkage with vital registries (South Africa), and apply these to mortality estimates in the other three regions. Age, gender and CD4 count at the initiation of therapy were the factors considered as predictors of mortality at 6, 12, 24 and >24 months after the start of treatment.

Results: Patient mortality was high during the first 6 months after therapy for all patient subgroups and exceeded 40 per 100 patient years among patients who started treatment at low CD4 count. This trend was seen regardless of region, demographic or disease-related risk factor. Mortality was under-reported by up to or exceeding 100% when comparing estimates obtained from passive monitoring of patient vital status.

Conclusions: Despite advances in antiretroviral treatment coverage many patients start treatment at very low CD4 counts and experience significant mortality during the first 6 months after treatment initiation. Active patient tracing and linkage with vital registries are critical in adjusting estimates of mortality, particularly in low- and middle-income settings.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Distribution of CD4 counts at antiretroviral therapy initiation in the Kenya, South Africa, West Africa, Asia Pacific and Latin America cohorts. Statistics for men are shown on the left and women on the right.
Figure 2
Figure 2
Adjusted estimates of mortality by age, gender and CD4 count antiretroviral therapy (ART) initiation in the Kenyan and South African cohorts.
Figure 3
Figure 3
Correction factors for mortality estimates derived from the Kenya and South Africa cohort data. ART, antiretroviral therapy.
Figure 4
Figure 4
Adjusted death rates among men (left) and women (right panels) in West Africa, Asia Pacific and Latin America. ART, antiretroviral therapy.
See this image and copyright information in PMC

References

    1. UNAIDS Global report: UNAIDS report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010
    1. Braitstein P, Brinkhof MW, Dabis F, et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 2006;367:817–24 - PubMed
    1. World Health Organization Towards universal access. Scaling up priority HIV/AIDS interventions in the health sector. Progress report 2008. Geneva: World Health Organization, 2008
    1. Mills EJ, Bakanda C, Birungi J, et al. Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda. AIDS 2011;25:851–5 - PubMed
    1. Brinkhof MW, Boulle A, Weigel R, et al. Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. PLoS Med 2009;6():e1000066. - PMC - PubMed

Publication types

Substances