title: Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam.
abstract: BACKGROUND
  There is a lack of knowledge on mortality and causes of death among human immunodeficiency virus (HIV)-infected patients after initiation of antiretroviral therapy (ART) in Vietnam. We investigated the mortality rate, risk factors, causes of death, and impact of enhanced adherence support on survival among 640 Vietnamese treatment-naïve HIV-infected patients receiving ART in a cluster randomized controlled trial.
  
  
  METHODS
  Patients in the intervention group received enhanced adherence from peer-supporters. Data were collected through medical records and a verbal autopsy questionnaire. We used Kaplan-Meier analysis to describe the survival trends and the Cox proportional hazard model to identify predictors of acquired immune deficiency syndrome (AIDS)-related deaths.
  
  
  RESULTS
  After a median follow-up of 15.2 months, there were 60 deaths, 73% of which occurred within 6 months. The mortality rate was 7.4/100 person-y and survival probability was 91% after 1 y. There was no significant difference in mortality rate between the intervention and the control groups. At baseline, the predictive factors for AIDS-related death were age >35 y, clinical stage 3 or 4, body mass index (BMI) <18 kg/m(2), CD4 count <100/μl, haemoglobin level <100 g/l, and plasma viral load >100,000 copies/ml. Tuberculosis (TB) was the most common cause of death (40%).
  
  
  CONCLUSIONS
  Early deaths occurred after ART, and delay of ART caused a significant decrease in CD4 count and a high mortality. Adherence support had no impact on survival at the early stage of ART. Early ART initiation and intensive follow-up of patients during the first 6 months of ART are therefore necessary to reduce AIDS-related mortality.
authors: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. doduy.cuong@gmail.com
authors: Do Duy
authors: do D
authors: Cuong
authors: Anna
authors: A
authors: Thorson
authors: Anders
authors: A
authors: Sönnerborg
authors: Nguyen Phuong
authors: NP
authors: Hoa
authors: Nguyen Thi Kim
authors: NT
authors: Chuc
authors: Ho Dang
authors: HD
authors: Phuc
authors: Mattias
authors: M
authors: Larsson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014744:Vietnam; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents