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Pre-treatment mortality and loss-to-follow-up in HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients eligible for antiretroviral therapy in The Gambia, West Africa

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dc.contributor.author Togun, T.
dc.contributor.author Peterson, I.
dc.contributor.author Jaffar, S.
dc.contributor.author Oko, F.
dc.contributor.author Okomo, U.
dc.contributor.author Peterson, K.
dc.contributor.author Jaye, A.
dc.date.accessioned 2012-04-26T08:59:02Z
dc.date.available 2012-04-26T08:59:02Z
dc.date.issued 2011
dc.identifier.issn 1742-6405
dc.identifier.doi http://dx.doi.org/10.1186/1742-6405-8-24
dc.identifier.other ITG-C6B
dc.identifier.other CLINIC
dc.identifier.other U-HIVCLI
dc.identifier.other DOI
dc.identifier.other Abstract
dc.identifier.other Electronic
dc.identifier.other UPD45
dc.identifier.other FTA
dc.identifier.uri http://hdl.handle.net/10390/6960
dc.description.abstract BACKGROUND: High early mortality rate among HIV infected patients following initiation of antiretroviral therapy (ART) in resource limited settings may indicate high pre-treatment mortality among ART-eligible patients. There is dearth of data on pre-treatment mortality in ART programmes in sub-Sahara Africa. This study aims to determine pre-treatment mortality rate and predictors of pre-treatment mortality among ART-eligible adult patients in a West Africa clinic-based cohort. METHODS: All HIV-infected patients aged 15 years or older eligible for ART between June 2004 and September 2009 were included in the analysis. Assessment for eligibility was based on the Gambia ART guideline. Survival following ART-eligibility was determined by Kaplan-Meier estimates and predictors of pre-treatment mortality determined by Cox proportional hazard models. RESULT: Overall, 790 patients were assessed as eligible for ART based on their clinical and/or immunological status among whom 510 (64.6%) started treatment, 26 (3.3%) requested transfer to another health facility, 136 (17.2%) and 118 (14.9%) were lost to follow-up and died respectively without starting ART. ART-eligible patients who died or were lost to follow-up were more likely to be male or to have a CD4 T-cell count < 100 cells/muL, while patients in WHO clinical stage 3 or 4 were more likely to die without starting treatment. The overall pre-treatment mortality rate was 21.9 deaths per 100 person-years (95% CI 18.3 - 26.2) and the rate for the composite end point of death or loss to follow-up was 47.1 per 100 person-years (95% CI 41.6 - 53.2). Independent predictors of pre-treatment mortality were CD4 T-cell count <100 cells/muL (adjusted Hazard ratio [AHR] 3.71; 95%CI 2.54 - 5.41) and WHO stage 3 or 4 disease (AHR 1.91; 95% CI 1.12 - 3.23). Forty percent of ART-eligible patients lost to follow-up seen alive at field visit cited difficulty with the requirement of disclosing their HIV status as reason for not starting ART. CONCLUSION: Approximately one third of ART-eligible patients did not start ART and pre-treatment mortality rate was found high among HIV infected patients in our cohort. CD4 T-cell count <100 cells/muL is the strongest independent predictor of pre-treatment mortality. The requirement to disclose HIV status as part of ART preparation counselling constitutes a huge barrier for eligible patients to access treatment. en
dc.language English en
dc.subject Viral diseases en
dc.subject HIV-1 en
dc.subject HIV-2 en
dc.subject HAART en
dc.subject Antiretrovirals en
dc.subject Eligibility en
dc.subject Mortality rates en
dc.subject Loss to follow-up en
dc.subject Compliance en
dc.subject Determinants en
dc.subject Predictors en
dc.subject Survival en
dc.subject CD4-positive-T-lymphocytes en
dc.subject CD4 lymphocyte count en
dc.subject Gambia en
dc.subject Africa, West en
dc.title Pre-treatment mortality and loss-to-follow-up in HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients eligible for antiretroviral therapy in The Gambia, West Africa en
dc.type Article-E en
dc.citation.issue 24 en
dc.citation.jtitle AIDS Research and Therapy en
dc.citation.volume 8 en
dc.citation.pages 1-8 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/21774813
dc.citation.jabbreviation AIDS Res Ther en


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