Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa

By S. Lawn, A. Harries, X. Anglaret, L. Myer, R. Wood. AIDS (London), 2008

715 citations recorded by the source corpus.

Two-thirds of the world's HIV-infected people live in sub-Saharan Africa, and more than 1.5 million of them die annually. As access to antiretroviral treatment has expanded within the region; early pessimism concerning the delivery of antiretroviral treatment using a large-scale public health approach has, at least in the short term, proved to be broadly unfounded. Immunological and virological responses to ART are similar to responses in patients treated in high-income countries. Despite this, however, early mortality rates in sub-Saharan Africa are very high; between 8 and 26% of patients die in the first year of antiretroviral treatment, with most deaths occurring in the first few months. Patients typically access antiretroviral treatment with advanced symptomatic disease, and mortality is strongly associated with baseline CD4 cell count less than 50 cells/μl and WHO stage 4 disease (AIDS). Although data are limited, leading causes of death appear to be tuberculosis, acute sepsis, cryptococcal meningitis, malignancy and wasting syndrome. Mortality rates are likely to depend not only on the care delivered by antiretroviral treatment programmes, but more fundamentally on how advanced disease is at programme enrolment and the quality of preceding healthcare. In addition to improving delivery of antiretroviral treatment and providing it free of charge to the patient, strategies to reduce mortality must include earlier diagnosis of HIV infection, strengthening of longitudinal HIV care and timely initiation of antiretroviral treatment. Health systems delays in antiretroviral treatment initiation must be minimized, especially in patients who present with advanced immunodeficiency.

Subfields: Epidemiology, Infectious Diseases, Virology

View Paper: https://www.semanticscholar.org/paper/18ed51e6fe8b52d25550bb354521730324144507

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

1. M. Fox
2. S. Rosen

Citations in the corpus

• Patient Retention in Antiretroviral Therapy Programs Up to Three Years on Treatment in Sub-Saharan Africa, 2007–2009: Systematic review (2010, background): “This finding, while not ideal, is notable in that most of the attrition occurred in the first 2 years on treatment, when both mortality (Lawn et al. 2008) and loss to follow-up are known to be high.”