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

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

Research output: Contribution to journalArticle

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Abstract

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

Original languageEnglish
JournalSexually Transmitted Infections
Volume88 Suppl 2
StatePublished - Dec 2012

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HIV
Mortality
CD4 Lymphocyte Count
Therapeutics
Registries
Southern Africa
Eastern Africa
Western Africa
Latin America
Kenya
Physiologic Monitoring
South Africa
Demography

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Yiannoutsos, C., Johnson, L. F., Boulle, A., Musick, B. S., Gsponer, T., Balestre, E., ... International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration, E. D. T. E. AIDS. IEA. C. (2012). Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. Sexually Transmitted Infections, 88 Suppl 2.

Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. / Yiannoutsos, Constantin; Johnson, Leigh Francis; Boulle, Andrew; Musick, Beverly Sue; Gsponer, Thomas; Balestre, Eric; Law, Matthew; Shepherd, Bryan E.; Egger, Matthias; International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration, Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.

In: Sexually Transmitted Infections, Vol. 88 Suppl 2, 12.2012.

Research output: Contribution to journalArticle

Yiannoutsos, C, Johnson, LF, Boulle, A, Musick, BS, Gsponer, T, Balestre, E, Law, M, Shepherd, BE, Egger, M & International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration, EDTEAIDSIEAC 2012, 'Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy.', Sexually Transmitted Infections, vol. 88 Suppl 2.
Yiannoutsos, Constantin ; Johnson, Leigh Francis ; Boulle, Andrew ; Musick, Beverly Sue ; Gsponer, Thomas ; Balestre, Eric ; Law, Matthew ; Shepherd, Bryan E. ; Egger, Matthias ; International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration, Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration. / Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. In: Sexually Transmitted Infections. 2012 ; Vol. 88 Suppl 2.
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