Mortality and treatment failure among HIV-infected adults in Dar Es Salaam, Tanzania
Chalamilla, G.; Hawkins, C.; Okuma, J.; Spiegelman, D.; Aveika, A.; Christian, B.; Koda, H.; Kaaya, S.; Mtasiwa, D.; Fawzi, W.
Journal of the International Association of Physicians in Aids Care 11(5): 296-304
2012
ISSN/ISBN: 1545-1097 PMID: 21673195 DOI: 10.1177/1545109711406733Document Number: 579350
Monitoring antiretroviral treatment (ART) outcomes is essential for assessing the success of HIV care and treatment programs in resource-limited settings (RLS). Longitudinal analyses of clinical and immunologic parameters in HIV-infected adults initiated on ART between November 2004 and June 2008 at Management and Development for Health (MDH)-Presidents Emergency Plan For AIDS Relief PEPFAR supported HIV care and treatment clinics in Tanzania. A total of 12 842 patients were analyzed (65.9% female, median baseline CD4 count, 106 cells/mm(3)). Significant improvements in immunologic status were observed with an increase in CD4 count to 298 (interquartile range [IQR] 199-416), 372 (256-490) and 427 (314-580) cells/mm(3), at 1, 2, and 3 years, respectively. Overall mortality was 13.1% (1682 of 12 842). Male sex, World Health Organization (WHO) stage III/IV, CD4 <200 cells/mm(3), hemoglobin (Hgb) <8.5 g/dL, and stavudine (d4T)-containing regimens were independently associated with early and overall mortality. Closer monitoring of males and patients with advanced HIV disease following ART initiation may improve clinical and immunologic outcomes in these individuals.