Cause-specific mortality and the contribution of immune reconstitution inflammatory syndrome in the first 3 years after antiretroviral therapy initiation in an urban African cohort.
BACKGROUND
Although many studies have reported high early mortality among patients enrolled in antiretroviral therapy (ART) programs in sub-Saharan Africa-particularly among those individuals with advanced immunodeficiency-few studies have reported the most common causes of these early deaths.


METHODS
We determined cause-specific mortality and the contribution of immune reconstitution inflammatory syndrome (IRIS) in a well-characterized patient cohort in Kampala, Uganda, over a 36-month period of ART.


RESULTS
In a cohort of patients who initiated antiretroviral therapy in Uganda, we observed a high early mortality rate among patients with advanced disease. The most common causes of death were tuberculosis and cryptococcal meningitis. The contribution of immune reconstitution inflammatory syndrome to mortality was limited.


CONCLUSIONS
We show a significant early mortality in our ART cohort in resource-limited settings that is driven by advanced human immunodeficiency virus disease and characterized by low CD4 cell counts. In our experience, the contribution of IRIS to this observed early mortality is limited.
Castelnuovo
Barbara
B
Infectious Diseases Institute, Kampala, Uganda. bcastelnuovo@idi.co.ug
Manabe
Yukari C
YC
Kiragga
Agnes
A
Kamya
Moses
M
Easterbrook
Philippa
P
Kambugu
Andrew
A
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000382:microbiology / Q000401:mortality*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology / Q000382:microbiology / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D016919:Meningitis, Cryptococcal / Q000276:immunology / Q000401:mortality; D016016:Proportional Hazards Models; D013997:Time Factors; D014376:Tuberculosis / Q000276:immunology / Q000401:mortality; D014454:Uganda
D044966:Anti-Retroviral Agents