Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda

David M. Moore, Constantin Yiannoutsos, Beverly S. Musick, Jordan Tappero, Richard Degerman, James Campbell, Willy Were, Frank Kaharuza, Lorraine N. Alexander, Robert Downing, Jonathan Mermin

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Up to 20% of people initiating antiretroviral therapy (ART) in sub-Saharan Africa die during the first year of treatment. Understanding the clinical conditions associated with mortality could potentially lead to effective interventions to prevent these deaths. Methods: We examined data from participants aged 18 years in the Home-Based AIDS Care project in Tororo, Uganda, to describe mortality over time and to determine clinical conditions associated with death. Survival analysis was used to examine variables associated with mortality at baseline and during follow-up. Results: A total of 112 (9.4%) deaths occurred in 1132 subjects (73% women) during a median of 3.0 years of ART. Mortality was 15.9 per 100 person-years during the first 3 months and declined to 0.3 per 100 person-years beyond 24 months after ART initiation. Tuberculosis (TB) was the most common condition associated with death (21% of deaths), followed by Candida disease (15%). In 43% of deaths, no specific clinical diagnosis was identified. Deaths within 3 months after ART initiation were associated with World Health Organization clinical stage III or IV at baseline, diagnosis of TB at baseline, a diagnosis of a non-TB opportunistic infection in follow-up and a body mass index ≤17 kg/m during follow-up. Mortality after 3 months of ART was associated with CD4 cell counts <200 cells per microliter, a diagnosis of TB or other opportunistic infection, adherence to therapy <95%, and low hemoglobin levels during follow-up. CONCLUSION: Potentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.

Original languageEnglish
Pages (from-to)289-296
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume58
Issue number3
DOIs
StatePublished - Nov 1 2011

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Uganda
HIV
Mortality
Tuberculosis
Opportunistic Infections
Therapeutics
Africa South of the Sahara
CD4 Lymphocyte Count
Survival Analysis
Candida
Acquired Immunodeficiency Syndrome
Hemoglobins
Body Mass Index
Infection

Keywords

  • Africa
  • anemia
  • antiretroviral therapy
  • mortality
  • tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda. / Moore, David M.; Yiannoutsos, Constantin; Musick, Beverly S.; Tappero, Jordan; Degerman, Richard; Campbell, James; Were, Willy; Kaharuza, Frank; Alexander, Lorraine N.; Downing, Robert; Mermin, Jonathan.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 58, No. 3, 01.11.2011, p. 289-296.

Research output: Contribution to journalArticle

Moore, DM, Yiannoutsos, C, Musick, BS, Tappero, J, Degerman, R, Campbell, J, Were, W, Kaharuza, F, Alexander, LN, Downing, R & Mermin, J 2011, 'Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda', Journal of Acquired Immune Deficiency Syndromes, vol. 58, no. 3, pp. 289-296. https://doi.org/10.1097/QAI.0b013e3182303716
Moore, David M. ; Yiannoutsos, Constantin ; Musick, Beverly S. ; Tappero, Jordan ; Degerman, Richard ; Campbell, James ; Were, Willy ; Kaharuza, Frank ; Alexander, Lorraine N. ; Downing, Robert ; Mermin, Jonathan. / Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda. In: Journal of Acquired Immune Deficiency Syndromes. 2011 ; Vol. 58, No. 3. pp. 289-296.
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