Research Article: Mortality of HIV-Infected Patients Starting Antiretroviral Therapy in Sub-Saharan Africa: Comparison with HIV-Unrelated Mortality

Date Published: April 28, 2009

Publisher: Public Library of Science

Author(s): Martin W. G. Brinkhof, Andrew Boulle, Ralf Weigel, Eugène Messou, Colin Mathers, Catherine Orrell, François Dabis, Margaret Pascoe, Matthias Egger, David R. Bangsberg

Abstract: Comparing mortality rates between patients starting HIV treatment and the general population in four African countries, Matthias Egger and colleagues find the gap decreases over time, especially with early treatment.

Partial Text: The widespread use since 1996 of highly active antiretroviral therapy (ART) has substantially improved the prognosis of HIV-infected patients both in industrialised and low-income settings [1]. Recent studies from industrialised countries have suggested that all-cause mortality in patients successfully treated with ART might approach that of the general population, and that in many patients mortality rates are comparable to those associated with other chronic conditions, such as diabetes [2]–[6]. Such comparisons are important to gain a better understanding of the treated history of HIV infection, to monitor and predict the progress of the HIV/AIDS epidemic, and to plan health services in the era of potent ART.

In this collaborative study of five treatment programmes in four countries in sub-Saharan Africa, the mortality of HIV-infected patients starting ART could be compared with that estimated for the corresponding non-HIV–infected general populations. In these countries, a large proportion of deaths among young and middle-aged adults are HIV-related. We found that mortality during the first 2 y of ART was more than 18 times higher than in the general population not infected by HIV. However, there was large variability between prognostic groups and over time: in patients with very low CD4 counts and advanced clinical disease, mortality was increased over 300 times in the first 3 mo of treatment, whereas in the second year of ART, patients who started with high CD4 counts and less advanced disease had mortality rates that were comparable to those estimated for non-HIV–infected individuals.



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