title: Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda.
abstract: BACKGROUND
  Up to 20% of people initiating antiretroviral therapy (ART) in sub-Saharan Africa die during the first year of treatment. Understanding the clinical conditions associated with mortality could potentially lead to effective interventions to prevent these deaths.
  
  
  METHODS
  We examined data from participants aged ≥18 years in the Home-Based AIDS Care project in Tororo, Uganda, to describe mortality over time and to determine clinical conditions associated with death. Survival analysis was used to examine variables associated with mortality at baseline and during follow-up.
  
  
  RESULTS
  A total of 112 (9.4%) deaths occurred in 1132 subjects (73% women) during a median of 3.0 years of ART. Mortality was 15.9 per 100 person-years during the first 3 months and declined to 0.3 per 100 person-years beyond 24 months after ART initiation. Tuberculosis (TB) was the most common condition associated with death (21% of deaths), followed by Candida disease (15%). In 43% of deaths, no specific clinical diagnosis was identified. Deaths within 3 months after ART initiation were associated with World Health Organization clinical stage III or IV at baseline, diagnosis of TB at baseline, a diagnosis of a non-TB opportunistic infection in follow-up and a body mass index ≤17 kg/m² during follow-up. Mortality after 3 months of ART was associated with CD4 cell counts <200 cells per microliter, a diagnosis of TB or other opportunistic infection, adherence to therapy <95%, and low hemoglobin levels during follow-up.
  
  
  CONCLUSIONS
  Potentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda.
authors.affiliation: Global AIDS Program, US Centers for Disease Control and Prevention (CDC), Entebbe, Uganda. dmoore@cfenet.ubc.ca
authors.forename: David M
authors.initials: DM
authors.lastname: Moore
authors.forename: Constantin T
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Musick
authors.forename: Jordan
authors.initials: J
authors.lastname: Tappero
authors.forename: Richard
authors.initials: R
authors.lastname: Degerman
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.forename: Willy
authors.initials: W
authors.lastname: Were
authors.forename: Frank
authors.initials: F
authors.lastname: Kaharuza
authors.forename: Lorraine N
authors.initials: LN
authors.lastname: Alexander
authors.forename: Robert
authors.initials: R
authors.lastname: Downing
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D016019:Survival Analysis; D014454:Uganda; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents