title: Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy.
abstract: OBJECTIVE
  To provide estimates of mortality among HIV-infected patients starting combination antiretroviral therapy.
  
  
  METHODS
  We report on the death rates from 122 925 adult HIV-infected patients aged 15 years or older from East, Southern and West Africa, Asia Pacific and Latin America. We use two methods to adjust for biases in mortality estimation resulting from loss from follow-up, based on double-sampling methods applied to patient outreach (Kenya) and linkage with vital registries (South Africa), and apply these to mortality estimates in the other three regions. Age, gender and CD4 count at the initiation of therapy were the factors considered as predictors of mortality at 6, 12, 24 and >24 months after the start of treatment.
  
  
  RESULTS
  Patient mortality was high during the first 6 months after therapy for all patient subgroups and exceeded 40 per 100 patient years among patients who started treatment at low CD4 count. This trend was seen regardless of region, demographic or disease-related risk factor. Mortality was under-reported by up to or exceeding 100% when comparing estimates obtained from passive monitoring of patient vital status.
  
  
  CONCLUSIONS
  Despite advances in antiretroviral treatment coverage many patients start treatment at very low CD4 counts and experience significant mortality during the first 6 months after treatment initiation. Active patient tracing and linkage with vital registries are critical in adjusting estimates of mortality, particularly in low- and middle-income settings.
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, USA. cyiannou@iupui.edu
authors.forename: Constantin Theodore
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Leigh Francis
authors.initials: LF
authors.lastname: Johnson
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Beverly Sue
authors.initials: BS
authors.lastname: Musick
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents