Low haemoglobin predicts early mortality among adults starting antiretroviral therapy in an HIV care programme in South Africa: a cohort study

Russell, Elizabeth C.; Charalambous, Salome; Pemba, Lindiwe; Churchyard, Gavin J.; Grant, Alison D.; Fielding, Katherine
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p433
Academic Journal
Background: Antiretroviral therapy (ART) has dramatically reduced morbidity and mortality among people with HIV infection; however, mortality after the start of ART is high in resource-limited settings. We investigated risk factors for mortality among adults starting ART in a multi-clinic community programme in South Africa. Methods: Cohort of adults starting ART at 27 clinics between February 2005 and June 2006, followed to 31st March 2007. Kaplan-Meier survival estimates were used to describe overall mortality. Shared frailty Cox regression was used to identify baseline risk factors for early mortality. Results: Among 1350 participants (median age 35.5 years, 60% female, median CD4 count 83/μL [interquartile range (27 -147)], median follow-up 13.4 months), there were 185 deaths, overall mortality rate 13/100 pyrs; for 0-3, 3-9 and >9 months from ART start mortality rates were 24, 13 and 6/100 pyrs respectively. 43% of the deaths were in the first 3 months of treatment. Risk factors for mortality in univariable analysis were baseline CD4 count, viral load, haemoglobin and body mass index, in multivariable analysis adjusting for age and gender, only CD4 count and haemoglobin remained independently associated with proportional hazards not being satisfied for haemoglobin. Adjusted hazard ratios (aHR) for participants with haemoglobin <8, 8.1-9.9, >11.9(f)/12.9 (m) g/mL were 4.99, 3.05 and 0.12 respectively comparing to 10-11.9 (f)/12.9 (m)g/mL in the first 3 months of ART. aHRs for CD4 counts were 0.40, 0.38 and 0.34 for 50-99, 100-200 and >200/μL comparing to <50/μL. Conclusions: The high mortality rate in the first 3 months underlines the need for earlier HIV diagnosis so that ART can be initiated earlier. Low haemoglobin and low CD4 count are both strong predictors of mortality, and could be used to identify individuals at high risk who might benefit from intensive case management.


Related Articles

  • Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study. Dahab, Mison; Charalambous, Salome; Karstaedt, Alan S.; Fielding, Katherine L.; Hamilton, Robin; La Grange, Lettie; Churchyard, Gavin J.; Grant, Alison D. // BMC Public Health;2010, Vol. 10 Issue 1, p430 

    Background: Many national antiretroviral therapy (ART) programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and...

  • Early treatment often best course in HIV.  // Clinical Advisor;Sep2010, Vol. 13 Issue 9, p16 

    The article reports on the recommendations proposed by an international panel on HIV antiretroviral therapy (ART) initiation and the decrease of mortality and incident rates of tuberculosis in Haiti due to early ART initiation as well as the ART-driven decline of HIV diagnosis in Canada.

  • Results of the Expanded HIV Testing Initiative -- 25 Jurisdictions, United States, 2007-2010. Viall, Abigail H.; Dooley, Samuel W.; Branson, Bernard M.; Duffy, Nadezhda; Mermin, Jonathan; Cleveland, Janet C.; Cagle, Chris; Lyon, Wendy A. // MMWR: Morbidity & Mortality Weekly Report;6/24/2011, Vol. 60 Issue 24, p805 

    The article discusses the outcomes of the expanded testing initiative concerning the human immunodeficiency virus (HIV) in the U.S. from 2007 to 2010. It estimates that around 20 per cent of the total population of U.S. people who are infected with the virus in 2008 were not aware of their...

  • Impact of depression on HIV outcomes in the HAART era. Joshua D. Hartzell; Igor E. Janke; Amy C. Weintrob // Journal of Antimicrobial Chemotherapy (JAC);Aug2008, Vol. 62 Issue 2, p246 

    Highly active antiretroviral therapy (HAART) has significantly decreased the morbidity and mortality of persons infected with HIV. The extent of the benefits, however, is not uniform, and certain factors including ethnicity, gender, baseline HIV viral load and CD4 T lymphocyte count, adherence...

  • Antiretroviral Therapy as HIV Prevention: Status and Prospects. Mayer, Kenneth H.; Venkatesh, Kartik K. // American Journal of Public Health;Oct2010, Vol. 100 Issue 10, p1867 

    As antiretroviral treatment of HIV infection has become increasingly accessible, attention has focused on whether these drugs can used for prevention because of increased tolerability of newer medications, decreased cost, and the limitations of other approaches. We review the status of...

  • Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort. Cingolani, Antonella; Cozzi-Lepri, Alessandro; Ammassari, Adriana; Mussini, Cristina; Ursitti, Maria Alessandra; Caramello, Pietro; Angarano, Gioacchino; Bonfanti, Paolo; De Luca, Andrea; Mura, Maria Stella; Girardi, Enrico; Antinori, Andrea; Monforte, Antonela D'Arminio // PLoS ONE;Feb2014, Vol. 9 Issue 2, p1 

    Background: Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE....

  • Therapy for HIV: Past, Present, and Future. Peters, B.S.; Conway, K. // Advances in Dental Research;Apr2011, Vol. 23 Issue 1, p23 

    Initial therapies for HIV infection comprised nucleoside analogues, but as single or dual agents, they failed to prevent disease progression. When a new class of drug was introduced, the protease inhibitors, an effective triple therapy became possible—namely, highly active antiretroviral...

  • Immune Activation While on Potent Antiretroviral Therapy Can Predict Subsequent CD4+ T-Cell Increases Through 15 Years of Treatment. Xinyan Zhang; Hunt, Peter W.; Hammer, Scott M.; Cespedes, Michelle S.; Patterson, Kristine B.; Bosch, Ronald J. // HIV Clinical Trials;Mar/Apr2013, Vol. 14 Issue 2, p61 

    Background: While persistent T-cell activation has been cross-sectionally associated with poor CD4+ T-cell restoration in HIV-infected individuals maintaining antiretroviral treatment (ART)-mediated viral suppression, it remains unclear whether CD8+ T-cell activation is of predictive effect on...

  • The Evolving Landscape of the Economics of HIV Treatment and Prevention. Nosyk, Bohdan; Montaner, Julio S. G. // PLoS Medicine;Feb2012, Vol. 9 Issue 2, p1 

    An essay related to evolving landscape of the economics of HIV treatment and prevention is presented. It suggests that the use of highly active antiretroviral therapy (HAART) is a highly effective means of preventing HIV transmission. It states that HAART has long been deemed to be a...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics