Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean.
BACKGROUND
Although nearly 2 million people live with HIV in Latin America and the Caribbean, mortality rates after initiation of highly active antiretroviral therapy (HAART) have not been well described.


METHODS
Five thousand one hundred fifty-two HIV-infected, antiretroviral-naive adults from clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru starting HAART during 1996-2007 were included. First-year mortality rates and their association with demographics, regimen, baseline CD4, and clinical stage were assessed.


RESULTS
Overall 1-year mortality rate was 8.3% [95% confidence interval (CI): 7.6% to 9.1%], although variable across sites: 2.6%, 3.7%, 6.0%, 13.0%, 10.8%, 3.5%, and 9.8% for clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, respectively. Eighty percent of deaths occurred within the first 6 months. Median baseline CD4 was 107 cells per milliliter, ranging from 79 (Peru) to 163 (Argentina). Mortality estimates adjusting for CD4 were similar across sites (1.1%-2.8% for CD4 = 200), except for Haiti, 7.5%, and Honduras, 7.0%. Death was associated with lower CD4 [adjusted hazard ratio for CD4 = 200 vs. CD4 = 50 was 0.58; 95% CI: 0.40 to 0.85] and clinical AIDS (hazard ratio = 3.1; 95% CI: 2.1 to 4.5).


CONCLUSIONS
Mortality rates were similar to those reported elsewhere for resource-limited settings. Disease stage at HAART initiation, treatment eligibility criteria, program age, and background mortality rates may explain some variability in prognosis between sites.
Tuboi
Suely H
SH
Projeto Praça Onze, Hospital Universitario Clementino Fraga Filho and Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Schechter
Mauro
M
McGowan
Catherine C
CC
Cesar
Carina
C
Krolewiecki
Alejandro
A
Cahn
Pedro
P
Wolff
Marcelo
M
Pape
Jean W
JW
Padgett
Denis
D
Madero
Juan Sierra
JS
Gotuzzo
Eduardo
E
Masys
Daniel R
DR
Shepherd
Bryan E
BE
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D053208:Kaplan-Meier Estimate; D007843:Latin America / Q000453:epidemiology; D008297:Male; D013997:Time Factors