Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe

Walker, A. Sarah, Prendergast, Andrew J., Mugyenyi, Peter, Munderi, Paula, Hakim, James, Kekitiinwa, Addy, Katabira, Elly, Gilks, Charles F., Kityo, Cissy, Nahirya-Ntege, Patricia, Nathoo, Kusum and Gibb, Diana M. (2012) Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe. Clinical Infectious Diseases, 55 12: 1707-1718. doi:10.1093/cid/cis797

Author Walker, A. Sarah
Prendergast, Andrew J.
Mugyenyi, Peter
Munderi, Paula
Hakim, James
Kekitiinwa, Addy
Katabira, Elly
Gilks, Charles F.
Kityo, Cissy
Nahirya-Ntege, Patricia
Nathoo, Kusum
Gibb, Diana M.
Title Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
Publication date 2012-12-01
Year available 2012
Sub-type Article (original research)
DOI 10.1093/cid/cis797
Volume 55
Issue 12
Start page 1707
End page 1718
Total pages 12
Place of publication Cary, NC United States
Publisher Oxford University Press
Language eng
Formatted abstract
Background. Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries.

Methods. We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus–infected adults (aged 18–73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda.

Results. One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0–49, 50–99 or ≥100 CD4 cells/μL was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4–15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%–4%: 9.1%; 5%–9%: 4.5%; ≥10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days).

Conclusions. Children ≥4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits. 
Keyword Resource Limited Settings
Randomized Controlled Trials
Hiv 1 Infected Patients
Proportional hazards
South Africa
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
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