Factors associated with mortality among HIV-infected patients in the era of highly active antiretroviral therapy in southern India.
OBJECTIVE
To describe the causes of mortality among the HIV-infected in southern India in the era of highly active antiretroviral therapy (HAART).


METHODS
Analyses of this patient cohort were conducted using the YRG Centre for AIDS Research and Education HIV Natural History Observational Database. Causes of death were then individually confirmed by patient chart review.


RESULTS
Sixty-nine deaths occurred within the inpatient unit; 25% were female and the median age of the 69 patients was 34 years. Over half of the patients (55%) died within three months of initiating HAART. At the time of enrollment into clinical care, the median CD4 cell count was 64 cells/microl (interquartile range (IQR) 37-134). At the time of initiating HAART, the median CD4 cell count was 58 cells/microl (IQR 31-67) for patients who died within 3 months of initiating HAART and 110 cells/microl (IQR 77-189) for patients who died more than 3 months after initiating HAART. Close to three-fourths of patients (70%) died from an AIDS-defining illness (ADI). The major ADI causes of death included Pneumocystis jiroveci pneumonia (22%), extrapulmonary tuberculosis (19%), CNS toxoplasmosis (12%), and pulmonary tuberculosis (10%). A tenth of patients died from cerebrovascular infarcts. Three patients (4%) died from non-Hodgkin lymphoma.


CONCLUSIONS
AIDS-related events continue to be the major source of mortality among the HIV-infected in southern India in the era of HAART. This mortality pattern justifies increased proactive efforts to identify HIV-infected patients and initiate HAART earlier, before patients present to care with advanced immunodeficiency.
Kumarasamy
N
N
YRG Centre for AIDS Research and Education, Voluntary Health Services, Taramani, Chennai 600113, India. kumarasamy@yrgcare.org
Venkatesh
Kartik K
KK
Devaleenol
Bella
B
Poongulali
S
S
Yephthomi
Tokugha
T
Pradeep
A
A
Saghayam
Suneeta
S
Flanigan
Timothy
T
Mayer
Kenneth H
KH
Solomon
Suniti
S
D017088:AIDS-Related Opportunistic Infections / Q000209:etiology / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death / Q000639:trends*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007194:India / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000401:mortality; D016781:Toxoplasmosis, Cerebral / Q000401:mortality; D014376:Tuberculosis / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000401:mortality