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

  • 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...

  • Updates on the prevention and treatment of AIDS. Jun Yong Choi; June Myung Kim // Journal of the Korean Medical Association / Taehan Uisa Hyophoe ;Feb2012, Vol. 55 Issue 2, p146 

    June 5, 2011, marked the 30th year since the first cases of acquired immunodeficiency syndrome (AIDS) were reported. From just five cases in the initial publication, AIDS has grown into a global pandemic that has resulted in the deaths of more than 33 million people around the world. There have...

  • 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...

  • Highly active antiretroviral treatment in countries with very limited resources: do we have cheaper alternatives? Colebunders, R.; Florence, E.; Lynen, L.; Bouckenooghe, A // International Journal of STD & AIDS;Jan2003, Vol. 14 Issue 1, p1 

    The article reflects on the alternatives for the highly active antiretroviral treatment (HAART) which has resulted in the decrease of AIDS-related mortality and treatment of HIV infection. The alternatives include the structured treatment interruptions (STI), and the use of less expensive drugs...

  • Treatment of acquired immunodeficiency syndrome with chinese medicine in China: Opportunity, advancement and challenges. Liu, Zhi-bin; Wang, Xin; Liu, Hui-juan; Jin, Yan-tao; Guo, Hui-jun; Jiang, Zi-qiang; Li, Zhen; Xu, Li-ran // Chinese Journal of Integrative Medicine;Aug2013, Vol. 19 Issue 8, p563 

    Chinese medicine (CM) has been used in the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) for 30 years and the demonstrated therapeutic effects of CM, such as reducing plasma HIV viral load, increasing CD4T cell counts, promoting immunity...

  • Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women. Cook, Judith A.; Cohen, Mardge H.; Grey, Dennis; Kirstein, Lynn; Burke, Jane; Anastos, Kathryn; Palacio, Herminia; Richardson, Jean; Wilson, Tracey E.; Young, Mary // American Journal of Public Health;Jan2002, Vol. 92 Issue 1, p82 

    Objectives. This study examined longitudinal trends in use of highly active antiretroviral therapy (HAART) among a cohort of HIV-positive participants in the Women's Interagency HIV Study. Methods. Beginning in 1994, 1690 HIV-positive women reported detailed information about their use of...

  • A Social-Ecological View of Barriers and Facilitators for HIV Treatment Adherence: Interviews with Puerto Rican HIV Patients. Castro, Eida M.; Santiago, Lydia E.; Jiménez, Julio C.; Dávila-Vargas, Daira; Rosal, Milagros C. // PLoS ONE;09/30/2015, Vol. 10 Issue 10, p1 

    Purpose: To identify perceived barriers and facilitators for HAART adherence among people living with HIV/AIDS in Southern Puerto Rico using a Social Ecological framework. Patients and Methods: Individual in-depths interviews were conducted with 12 HIV patients with a history of HAART...


Read the Article


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

Try another library?
Sign out of this library

Other Topics