Boulle, Andrew ORCID: 0000-0002-7713-8062, Schomaker, Michael ORCID: 0000-0002-8475-0591, May, Margaret T., Hogg, Robert S., Shepherd, Bryan E., Monge, Susana, Keiser, Olivia ORCID: 0000-0001-8191-2789, Lampe, Fiona C., Giddy, Janet, Ndirangu, James ORCID: 0000-0002-2768-5631, Garone, Daniela, Fox, Matthew, Ingle, Suzanne M., Reiss, Peter, Dabis, Francois, Costagliola, Dominique ORCID: 0000-0003-0765-0869, Castagna, Antonella ORCID: 0000-0002-8338-9714, Ehren, Kathrin, Campbell, Colin ORCID: 0000-0002-6239-3378, Gill, M. John, Saag, Michael, Justice, Amy C., Guest, Jodie ORCID: 0000-0002-3650-3975, Crane, Heidi M., Egger, Matthias ORCID: 0000-0001-7462-5132 and Sterne, Jonathan A. C. (2014). Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America: A Collaborative Analysis of Prospective Studies. PLos Med., 11 (9). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1549-1676

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Abstract

Background High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. Methods and Findings Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 2001-2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/mu l in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count <50 cells/mu l. Cumulative mortality at 4 years was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. Mortality was initially much lower in Europe and North America than South Africa, but the differences were reduced or reversed (North America) at longer durations on ART (adjusted rate ratios 0.46, 95% CI 0.37-0.58, and 1.62, 95% CI 1.27-2.05 between 24 and 48 months on ART comparing Europe and North America to South Africa). While bias due to under-ascertainment of mortality was minimised through death registry linkage, residual bias could still be present due to differing approaches to and frequency of linkage. Conclusions After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Boulle, AndrewUNSPECIFIEDorcid.org/0000-0002-7713-8062UNSPECIFIED
Schomaker, MichaelUNSPECIFIEDorcid.org/0000-0002-8475-0591UNSPECIFIED
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hogg, Robert S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, Bryan E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monge, SusanaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Keiser, OliviaUNSPECIFIEDorcid.org/0000-0001-8191-2789UNSPECIFIED
Lampe, Fiona C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Giddy, JanetUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ndirangu, JamesUNSPECIFIEDorcid.org/0000-0002-2768-5631UNSPECIFIED
Garone, DanielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fox, MatthewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ingle, Suzanne M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reiss, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dabis, FrancoisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Costagliola, DominiqueUNSPECIFIEDorcid.org/0000-0003-0765-0869UNSPECIFIED
Castagna, AntonellaUNSPECIFIEDorcid.org/0000-0002-8338-9714UNSPECIFIED
Ehren, KathrinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Campbell, ColinUNSPECIFIEDorcid.org/0000-0002-6239-3378UNSPECIFIED
Gill, M. JohnUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guest, JodieUNSPECIFIEDorcid.org/0000-0002-3650-3975UNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Egger, MatthiasUNSPECIFIEDorcid.org/0000-0001-7462-5132UNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-431415
DOI: 10.1371/journal.pmed.1001718
Journal or Publication Title: PLos Med.
Volume: 11
Number: 9
Date: 2014
Publisher: PUBLIC LIBRARY SCIENCE
Place of Publication: SAN FRANCISCO
ISSN: 1549-1676
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
SUB-SAHARAN AFRICA; TREATMENT PROGRAM; FOLLOW-UP; HIV-1-INFECTED PATIENTS; DISEASE PROGRESSION; SCALE-UP; COHORT; OUTCOMES; ADULTS; 1STMultiple languages
Medicine, General & InternalMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/43141

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