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Impact of HIV-associated conditions on mortality in people commencing anti-retroviral therapy in resource limited settings

Marshall, Catherine S., Curtis, Andrea J., Spelman, Tim, O'Brien, Daniel P., Greig, Jane, Shanks, Leslie, du Cros, Philipp, Casas, Esther C., da Fonseca, Marcio Silveira, Athan, Eugene and Elliot, Julian H. 2013, Impact of HIV-associated conditions on mortality in people commencing anti-retroviral therapy in resource limited settings, PLoS one, vol. 8, no. 7, Article number: e68445, pp. 1-8, doi: 10.1371/journal.pone.0068445.

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Title Impact of HIV-associated conditions on mortality in people commencing anti-retroviral therapy in resource limited settings
Author(s) Marshall, Catherine S.
Curtis, Andrea J.
Spelman, Tim
O'Brien, Daniel P.
Greig, Jane
Shanks, Leslie
du Cros, Philipp
Casas, Esther C.
da Fonseca, Marcio Silveira
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Elliot, Julian H.
Journal name PLoS one
Volume number 8
Issue number 7
Season Article number: e68445
Start page 1
End page 8
Total pages 8
Publisher Public Library of Science
Place of publication San Francisco, Calif.
Publication date 2013-07
ISSN 1932-6203
Summary Objectives: To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS).

Design, Setting: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010.

Subjects, Participants:
36,664 study participants with median ART follow-up of 1.26 years (IQR 0.55–2.27).

Outcome Measures: Using a proportional hazards model we identified factors associated with mortality, including the occurrence of specific WHO clinical stage 3 and 4 conditions during the 6-months following ART initiation.

Results: There were 2922 deaths during follow-up (8.0%). The crude mortality rate was 5.41 deaths per 100 person-years (95% CI: 5.21–5.61). The diagnosis of any WHO stage 3 or 4 condition during the first 6 months of ART was associated with
increased mortality (HR: 2.21; 95% CI: 1.97–2.47). After adjustment for age, sex, region and pre-ART CD4 count, a diagnosis of extrapulmonary cryptococcosis (aHR: 3.54; 95% CI: 2.74–4.56), HIV wasting syndrome (aHR: 2.92; 95%CI: 2.21 -3.85), nontuberculous mycobacterial infection (aHR: 2.43; 95% CI: 1.80–3.28) and Pneumocystis pneumonia (aHR: 2.17; 95% CI 1.80–3.28) were associated with the greatest increased mortality. Cerebral toxoplasmosis, pulmonary and extra-pulmonary
tuberculosis, Kaposi’s sarcoma and oral and oesophageal candidiasis were associated with increased mortality, though at lower rates.

Conclusions:
A diagnosis of certain WHO stage 3 and 4 conditions is associated with an increased risk of mortality in those initiating ART in RLS. This information will assist initiatives to reduce excess mortality, including prioritization of resources for
diagnostics, therapeutic interventions and research.
Language eng
DOI 10.1371/journal.pone.0068445
Field of Research 111706 Epidemiology
Socio Economic Objective 920109 Infectious Diseases
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30061741

Document type: Journal Article
Collections: School of Medicine
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Citation counts: TR Web of Science Citation Count  Cited 9 times in TR Web of Science
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Created: Wed, 19 Mar 2014, 08:32:08 EST by Penny Andrews

Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.