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Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania

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dc.contributor.author Johannessen, A.
dc.contributor.author Naman, E.
dc.contributor.author Ngowi, B.J
dc.contributor.author Sandvik, L.
dc.contributor.author Matee, M.I
dc.contributor.author Aglen, H.E
dc.contributor.author Gundersen, S.G
dc.contributor.author Bruun, J.N
dc.date.accessioned 2013-02-13T10:26:34Z
dc.date.available 2013-02-13T10:26:34Z
dc.date.issued 2008
dc.identifier.citation Johannessen, A., Naman, E., Ngowi, B. J., Sandvik, L., Matee, M. I., Aglen, H. E., ... & Bruun, J. N. (2008). Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania. BMC Infectious Diseases, 8(1), 52.
dc.identifier.issn 1471-2334-8-52
dc.identifier.other doi:10.1186/1471-2334-8-52
dc.identifier.uri http://hdl.handle.net/123456789/398
dc.description.abstract Background: Studies of antiretroviral therapy (ART) programs in Africa have shown high initial mortality. Factors contributing to this high mortality are poorly described. The aim of the present study was to assess mortality and to identify predictors of mortality in HIV-infected patients starting ART in a rural hospital in Tanzania. Methods: This was a cohort study of 320 treatment-naïve adults who started ART between October 2003 and November 2006. Reliable CD4 cell counts were not available, thus ART initiation was based on clinical criteria in accordance with WHO and Tanzanian guidelines. Kaplan- Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality. Results: Patients were followed for a median of 10.9 months (IQR 2.9–19.5). Overall, 95 patients died, among whom 59 died within 3 months of starting ART. Estimated mortality was 19.2, 29.0 and 40.7% at 3, 12 and 36 months, respectively. Independent predictors of mortality were severe anemia (hemoglobin <8 g/dL; adjusted hazard ratio [AHR] 9.20; 95% CI 2.05–41.3), moderate anemia (hemoglobin 8–9.9 g/dL; AHR 7.50; 95% CI 1.77–31.9), thrombocytopenia (platelet count <150 × 109/L; AHR 2.30; 95% CI 1.33–3.99) and severe malnutrition (body mass index <16 kg/m2; AHR 2.12; 95% CI 1.06–4.24). Estimated one year mortality was 55.2% in patients with severe anemia, compared to 3.7% in patients without anemia (P < 0.001). Conclusion: Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings. en_GB
dc.language.iso en en_GB
dc.publisher BioMed Central en_GB
dc.relation.ispartofseries BMC Infectious Diseases.8:52
dc.subject Predictors of mortality en_GB
dc.subject HIV-infected patients en_GB
dc.subject antiretroviral therapy en_GB
dc.subject Tanzania en_GB
dc.title Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania en_GB
dc.type Article en_GB


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