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
. 2016;3(1):178-185.

Early Versus Delayed Mortality among HIV Infected Patients Initiating Highly Active Antiretroviral Therapy in Tanzania

Peter Memiah  1 , Justice Mbizo  1 , Patience Komba  2 , Euphrasia Telwa  2 , Sekela Mwakyusa  2 , Abuu Maghimbi  2 , Martine Etienne  3 , Aimee Phillips  4 , Courtney Swain  4 , Aaron Hill  1 , Constance Shumba  4 , Sibhatu Biadgilign  5   6
Affiliations

Early Versus Delayed Mortality among HIV Infected Patients Initiating Highly Active Antiretroviral Therapy in Tanzania

Peter Memiah et al. J Res Appl Sci. 2016.

Abstract

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 timeframe. Bivariate and multivariate regression models were used to identify independent predictors of mortality and to calculate odds ratios. From the population, early deaths (within 3 months of ART initiation) occurred in 359 of the 991 cases, which represented 36.2%; while delayed deaths (after 3 months of ART initiation) occurred in 632 of 991 (63.8%). The average time to death for those who died within 3 months was 1 month compared to 22 months among those who died at > 3 months since initiation of ARV. In multivariate analysis, patients who were on WHO stage IV, had fever and cough symptoms at 6 months prior to death and patients with 0-1, 2-3, and 4-6 clinic visits had a higher risk of death in the first 3 months. Mortality among patients started on ART seems to be high. Where possible, healthcare providers should do more to vigorously monitor patients before starting them on ART for better outcomes. Additionally, public health efforts to encourage early testing and entry into treatment must be scaled up in resource poor countries to gain some lead-time and to keep the virus under control, sustain immune function, and delay the onset of opportunistic infections.

Keywords: Delayed; Early; HAART; HIV; Mortality.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interests All authors declare that they have no conflict of interests associated with the publication of this paper.

References

    1. Cockerham LSR, Zolopa A, Rimland D, Lewis CE, Bacchetti P, Grunfeld C, Shlipak M, Tien PC, 2010. Association of HIV infection, demographic and cardiovascular risk factors with all-cause mortality in the recent HAART era. J Acquir Immune Defic Syndr, 53(1): 102–106. - PMC - PubMed
    1. Falster KCJ, Donovan B, Duncombe C, Mulhall B, Sowden D, Zhou J, Law MG, 2009. Australian HIV Observational Database; TREAT Asia HIV Observational Database: AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the era of combination antiretroviral treatment. AIDS, 23(17): 2323–2336 - PMC - PubMed
    1. Lawn SDHA, Anglaret X, Myer L, Wood R, 2008. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 2008, 22(15):1897–1908. - PMC - PubMed
    1. Braitstein PBM, Dabis F, Schechter M, Boulle A, Miotti P, Wood R, Laurent C, Sprinz E, Seyler C, Bangsberg DR, Balestre E, Sterne JA, May M, Egger M, 2006. Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration; ART Cohort Collaboration (ART-CC) groups: Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet, 367(9513):817–824. - PubMed
    1. WHO, 2011. Global health sector strategy on HIV/AIDS 2011-2015 World Health Organization, ISBN: 978 92 4 150165 1.

LinkOut - more resources