PT  - JOURNAL ARTICLE
AU  - Constantin Theodore Yiannoutsos
AU  - Leigh Francis Johnson
AU  - Andrew Boulle
AU  - Beverly Sue Musick
AU  - Thomas Gsponer
AU  - Eric Balestre
AU  - Matthew Law
AU  - Bryan E Shepherd
AU  - Matthias Egger
TI  - Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy
AID  - 10.1136/sextrans-2012-050658
DP  - 2012 Dec 01
TA  - Sexually Transmitted Infections
PG  - i33--i43
VI  - 88
IP  - Suppl 2
4099  - http://sti.bmj.com/content/88/Suppl_2/i33.short
4100  - http://sti.bmj.com/content/88/Suppl_2/i33.full
SO  - Sex Transm Infect2012 Dec 01; 88
AB  - Objective To provide estimates of mortality among HIV-infected patients starting combination antiretroviral therapy. Methods We report on the death rates from 122 925 adult HIV-infected patients aged 15 years or older from East, Southern and West Africa, Asia Pacific and Latin America. We use two methods to adjust for biases in mortality estimation resulting from loss from follow-up, based on double-sampling methods applied to patient outreach (Kenya) and linkage with vital registries (South Africa), and apply these to mortality estimates in the other three regions. Age, gender and CD4 count at the initiation of therapy were the factors considered as predictors of mortality at 6, 12, 24 and >24 months after the start of treatment. Results Patient mortality was high during the first 6 months after therapy for all patient subgroups and exceeded 40 per 100 patient years among patients who started treatment at low CD4 count. This trend was seen regardless of region, demographic or disease-related risk factor. Mortality was under-reported by up to or exceeding 100% when comparing estimates obtained from passive monitoring of patient vital status. Conclusions Despite advances in antiretroviral treatment coverage many patients start treatment at very low CD4 counts and experience significant mortality during the first 6 months after treatment initiation. Active patient tracing and linkage with vital registries are critical in adjusting estimates of mortality, particularly in low- and middle-income settings.