title: Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe.
abstract: BACKGROUND
  Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries.
  
  
  METHODS
  We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus-infected adults (aged 18-73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda.
  
  
  RESULTS
  One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0-49, 50-99 or ≥ 100 CD4 cells/μL was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4-15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%-4%: 9.1%; 5%-9%: 4.5%; ≥ 10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days).
  
  
  CONCLUSIONS
  Children ≥ 4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits.
authors.affiliation: MRC Clinical Trials Unit, London, UK. asw@ctu.mrc.ac.uk
authors.forename: A Sarah
authors.initials: AS
authors.lastname: Walker
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Prendergast
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Addy
authors.initials: A
authors.lastname: Kekitiinwa
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Charles F
authors.initials: CF
authors.lastname: Gilks
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.forename: Patricia
authors.initials: P
authors.lastname: Nahirya-Ntege
authors.forename: Kusum
authors.initials: K
authors.lastname: Nathoo
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D012306:Risk; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents