The response to treatment and risk factors for early mortality following initiation of combination antiretrovirals ( ARVs) in a cohort of African patients are described in a retrospective cohort design. Medical history, laboratory parameters, and mortality data were reviewed for patients initiating ARVs in 12 clinical centers in Mozambique, Tanzania, and Malawi. Among 3456 HIV-1- infected patients who received ARVs for more than 6 months, at baseline 72% had WHO clinical stages 3/4, 7% had a viral load < 400 copies/ml, and 38% had a CD4 cell count > 200/mu l. One year later, 78% had undetectable virus loads and 79% had CD4 cell counts > 200 cells/ mm(3). In the first year of HAART 260 deaths occurred ( 97 per 1000 person/years) with mortality peaking in the first 3 months. The highest mortality was observed in patients with low BMI, low hemoglobin levels, and CD4 values > 200 cells/mu l at baseline. Mortality rates following initiation of HAART are higher in patients in resource-limited areas, particularly in the first 90 days following treatment initiation. HAART initiated at higher CD4 cell count levels, especially among malnourished and/or anemic patients, will carry significant public health impact.

Marazzi, M., Liotta, G., Germano, P., Guidotti, G., Altan, A., Ceffa, S., et al. (2008). Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating antiretroviral therapy in resource-limited settings. AIDS RESEARCH AND HUMAN RETROVIRUSES, 24(4), 555-560 [10.1089/aid.2007.0217].

Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating antiretroviral therapy in resource-limited settings

LIOTTA, GIUSEPPE;PALOMBI, LEONARDO
2008-01-01

Abstract

The response to treatment and risk factors for early mortality following initiation of combination antiretrovirals ( ARVs) in a cohort of African patients are described in a retrospective cohort design. Medical history, laboratory parameters, and mortality data were reviewed for patients initiating ARVs in 12 clinical centers in Mozambique, Tanzania, and Malawi. Among 3456 HIV-1- infected patients who received ARVs for more than 6 months, at baseline 72% had WHO clinical stages 3/4, 7% had a viral load < 400 copies/ml, and 38% had a CD4 cell count > 200/mu l. One year later, 78% had undetectable virus loads and 79% had CD4 cell counts > 200 cells/ mm(3). In the first year of HAART 260 deaths occurred ( 97 per 1000 person/years) with mortality peaking in the first 3 months. The highest mortality was observed in patients with low BMI, low hemoglobin levels, and CD4 values > 200 cells/mu l at baseline. Mortality rates following initiation of HAART are higher in patients in resource-limited areas, particularly in the first 90 days following treatment initiation. HAART initiated at higher CD4 cell count levels, especially among malnourished and/or anemic patients, will carry significant public health impact.
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/42 - Igiene Generale e Applicata
English
Con Impact Factor ISI
cotrimoxazole; hemoglobin; lamivudine; nelfinavir; nevirapine; stavudine; zidovudine; adult; anamnesis; article; blood toxicity; body mass; CD4 lymphocyte count; cohort analysis; combination chemotherapy; controlled study; disease severity; female; follow up; health center; hemoglobin blood level; highly active antiretroviral therapy; human; Human immunodeficiency virus 1; Human immunodeficiency virus 1 infection; liver toxicity; major clinical study; Malawi; male; mortality; Mozambique; priority journal; proportional hazards model; risk factor; Tanzania; treatment duration; treatment response; virus detection; virus load; world health organization; Adult; Anemia; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cohort Studies; Developing Countries; Female; HIV Infections; HIV-1; Humans; Malawi; Male; Malnutrition; Mozambique; Proportional Hazards Models; Retrospective Studies; Risk Factors; Tanzania; Treatment Outcome
Marazzi, M., Liotta, G., Germano, P., Guidotti, G., Altan, A., Ceffa, S., et al. (2008). Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating antiretroviral therapy in resource-limited settings. AIDS RESEARCH AND HUMAN RETROVIRUSES, 24(4), 555-560 [10.1089/aid.2007.0217].
Marazzi, M; Liotta, G; Germano, P; Guidotti, G; Altan, A; Ceffa, S; San Lio, M; Nielsen Saines, K; Palombi, L
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/38575
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