Risk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi.

Hdl Handle:
http://hdl.handle.net/10144/18297
Title:
Risk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi.
Authors:
Zachariah, R; Fitzgerald, M; Massaquoi, M; Pasulani, O; Arnould, L; Makombe, S D; Harries, A D
Journal:
AIDS (London, England)
Abstract:
OBJECTIVES: Among adults started on antiretroviral treatment (ART) in a rural district hospital (a) to determine the cumulative proportion of deaths that occur within 3 and 6 months of starting ART, and (b) to identify risk factors that may be associated with such mortality. DESIGN AND SETTING: A cross-sectional analytical study set in Thyolo district, Malawi. METHODS: Over a 2-year period (April 2003 to April 2005) mortality within the first 3 and 6 months of starting ART was determined and risk factors were examined. RESULTS: A total of 1507 individuals (517 men and 990 women), whose median age was 35 years were included in the study. There were a total of 190 (12.6%) deaths on ART of which 116 (61%) occurred within the first 3 months (very early mortality) and 150 (79%) during the first 6 months of initiating ART. Significant risk factors associated with such mortality included WHO stage IV disease, a baseline CD4 cell count under 50 cells/mul and increasing grades of malnutrition. A linear trend in mortality was observed with increasing grades of malnutrition (chi for trend = 96.1, P </= 0.001) and decreasing CD4 cell counts (chi for trend = 72.4, P </= 0.001). Individuals who were severely malnourished [body mass index (BMI) < 16.0 kg/m] had a six times higher risk of dying in the first 3 months than those with a normal nutritional status. CONCLUSIONS: Among individuals starting ART, the BMI and clinical staging could be important screening tools for use to identify and target individuals who, despite ART, are still at a high risk of early death.
Affiliation:
Medecins sans Frontieres, Operational Research, Brussels Operational Center, Belgium. zachariah@internet.lu
Issue Date:
28-Nov-2006
URI:
http://hdl.handle.net/10144/18297
DOI:
10.1097/QAD.0b013e32801086b0
PubMed ID:
17117022
Language:
en
ISSN:
0269-9370
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorFitzgerald, M-
dc.contributor.authorMassaquoi, M-
dc.contributor.authorPasulani, O-
dc.contributor.authorArnould, L-
dc.contributor.authorMakombe, S D-
dc.contributor.authorHarries, A D-
dc.date.accessioned2008-02-14T12:49:51Z-
dc.date.available2008-02-14T12:49:51Z-
dc.date.issued2006-11-28-
dc.identifier.citationRisk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi. 2006, 20 (18):2355-60 AIDSen
dc.identifier.issn0269-9370-
dc.identifier.pmid17117022-
dc.identifier.doi10.1097/QAD.0b013e32801086b0-
dc.identifier.urihttp://hdl.handle.net/10144/18297-
dc.description.abstractOBJECTIVES: Among adults started on antiretroviral treatment (ART) in a rural district hospital (a) to determine the cumulative proportion of deaths that occur within 3 and 6 months of starting ART, and (b) to identify risk factors that may be associated with such mortality. DESIGN AND SETTING: A cross-sectional analytical study set in Thyolo district, Malawi. METHODS: Over a 2-year period (April 2003 to April 2005) mortality within the first 3 and 6 months of starting ART was determined and risk factors were examined. RESULTS: A total of 1507 individuals (517 men and 990 women), whose median age was 35 years were included in the study. There were a total of 190 (12.6%) deaths on ART of which 116 (61%) occurred within the first 3 months (very early mortality) and 150 (79%) during the first 6 months of initiating ART. Significant risk factors associated with such mortality included WHO stage IV disease, a baseline CD4 cell count under 50 cells/mul and increasing grades of malnutrition. A linear trend in mortality was observed with increasing grades of malnutrition (chi for trend = 96.1, P </= 0.001) and decreasing CD4 cell counts (chi for trend = 72.4, P </= 0.001). Individuals who were severely malnourished [body mass index (BMI) < 16.0 kg/m] had a six times higher risk of dying in the first 3 months than those with a normal nutritional status. CONCLUSIONS: Among individuals starting ART, the BMI and clinical staging could be important screening tools for use to identify and target individuals who, despite ART, are still at a high risk of early death.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subject.meshAIDS-Related Opportunistic Infectionsen
dc.subject.meshAdulten
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshCD4 Lymphocyte Counten
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshNutrition Disordersen
dc.subject.meshRisk Factorsen
dc.subject.meshRural Healthen
dc.subject.meshSex Distributionen
dc.subject.meshSurvival Analysisen
dc.subject.meshTreatment Outcomeen
dc.titleRisk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi.en
dc.contributor.departmentMedecins sans Frontieres, Operational Research, Brussels Operational Center, Belgium. zachariah@internet.luen
dc.identifier.journalAIDS (London, England)en

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