Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes

M May, A Boulle, S Phiri, E Messou, L Myer, R Wood, O Keiser, J Sterne, F Dabis, M Egger

Research output: Contribution to journalArticle (Academic Journal)peer-review

175 Citations (Scopus)

Abstract

Background
Prognostic models have been developed for patients infected with HIV-1 who start combination antiretroviral therapy (ART) in high-income countries, but not for patients in sub-Saharan Africa. We developed two prognostic models to estimate the probability of death in patients starting ART in sub-Saharan Africa.
Methods
We analysed data for adult patients who started ART in four scale-up programmes in Côte d'Ivoire, South Africa, and Malawi from 2004 to 2007. Patients lost to follow-up in the first year were excluded. We used Weibull survival models to construct two prognostic models: one with CD4 cell count, clinical stage, bodyweight, age, and sex (CD4 count model); and one that replaced CD4 cell count with total lymphocyte count and severity of anaemia (total lymphocyte and haemoglobin model), because CD4 cell count is not routinely measured in many African ART programmes. Death from all causes in the first year of ART was the primary outcome.
Findings
912 (8·2%) of 11 153 patients died in the first year of ART. 822 patients were lost to follow-up and not included in the main analysis; 10 331 patients were analysed. Mortality was strongly associated with high baseline CD4 cell count (≥200 cells per μL vs
Translated title of the contributionPrognosis of HIV-1 infected patients starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes
Original languageEnglish
Pages (from-to)449 - 457
Number of pages9
JournalLancet
Volume376
Issue number9739
DOIs
Publication statusPublished - Aug 2010

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