Predictors of Mortality in Patients Initiating Antiretroviral Therapy in
Objective: To identify predictors of mortality in patients initiating antiretroviral therapy (ART) in Durban, South Africa.
Design: We conducted a retrospective cohort study analyzing data on patients who presented to McCord Hospital and started ART between January 1, 1999 and February 29, 2004. We performed univariate and multivariate analysis and constructed Kaplan Meier curves to assess predictors.
Results: Three hundred and nine patients were included. Forty-nine (16%) patients died by the conclusion of the study. In univariate analysis, the strongest predictors of mortality were CD4 cell count <50/mm3 [hazard ratio (HR) 3.70; 95% confidence interval (1.96, 7.14)], hemoglobin <8 g/dl [HR 1.23 (1.08, 1.40)], history of oral candidiasis [HR 3.17 (1.70, 5.87)] and history of cryptococcal meningitis [HR 2.76 (1.80, 19.2)]. CD4 cell count <50/mm3 [HR 3.08 (1.54, 5.88)] and history of oral candidiasis [HR 2.58 (1.37, 4.88)] remained significant in multivariate analysis. History of tuberculosis was not a significant predictor of mortality.
Conclusions: Simple clinical and laboratory data independently predict mortality and allow for risk stratification in patients initiating ART in South Africa. Interventions leading to increased identification of patients prior to the development of these clinical markers and earlier initiation of ART will help to ensure maximum benefits of therapy.
Bisola Olubunmi Ojikutu, Harvard Medical School
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Date published: 2008-03-05
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