title: Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi.
abstract: OBJECTIVE
  To report on the cumulative proportion of deaths occurring within 3 months of starting antiretroviral treatment (ART) and to identify factors associated with such deaths, among adults at primary health centres in a rural district of Malawi.
  
  
  METHODS
  Retrospective cohort study: from June 2006 to April 2008, deaths occurring over a 3-month period were determined and risk factors examined.
  
  
  RESULTS
  A total of 2316 adults (706 men and 1610 women; median age 35 years) were included in the analysis and followed up for a total of 1588 person-years (PY); 277 (12%) people died, of whom 206 (74%) people died within 3 months of initiating ART (cumulative incidence: 13.0; 95% confidence interval: 11.3-14.8 per 100 PY of follow-up). Significant risk factors associated with early deaths included male sex, WHO stage 4 disease, oesophageal or persistent oral candidiasis and unexplained presumed or measured weight loss >10%. One in every 3 patients who either died or was lost to follow up had unexplained weight loss >10%, and survival in this group was significantly different from patients without this condition.
  
  
  CONCLUSIONS
  Seven in 10 individuals initiating ART at primary health centres die early. Specific groups of patients are at higher risk of such mortality and should receive priority attention, care and support.
authors.affiliation: Medecins sans Frontieres, Medical department, Brussels, Belgium. zachariah@internet.lu
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Katie
authors.initials: K
authors.lastname: Harries
authors.forename: Massaquoi
authors.initials: M
authors.lastname: Moses
authors.forename: Marcel
authors.initials: M
authors.lastname: Manzi
authors.forename: Arnould
authors.initials: A
authors.lastname: Line
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000209:etiology / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D015497:HIV-1; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000401:mortality*; D017410:Practice Guidelines as Topic; D012423:Rural Health; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality*; D015431:Weight Loss
chemical_list: D044966:Anti-Retroviral Agents