title: Risk factors for mortality in a south Indian population on generic antiretroviral therapy.
abstract: BACKGROUND
  Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regimens, simplified approaches to clinical decision making and basic lab monitoring have reported high mortality rates. We determined the risk factors for mortality among HIV-infected adults following the initiation of ART from a single center in south India.
  
  
  METHODS
  ART-naive HIV-infected south Indian adults attending the Infectious Diseases clinic in a 2000-bed academic medical center in south India who were initiated on ART (generic, fixed-dose combinations) as per the national guidelines were followed up. Cases (32 patients who died) were compared with age and sex matched controls.
  
  
  RESULTS
  Eight-hundred and twenty-two patients were started on ART from January 1, 2000 to December 31, 2008. The cumulative mortality was 6.8% (56/822). Among the cases mean age was 44 years, 18% were women and mean CD4 counts was 107 cells/microl. Among the controls mean age was 41 years, 18% were women and mean CD4 counts were 113 cells/microl. Stavudine based ART was predominant 62.5% in the cases vs 37.5% in the controls, followed by zidovudine based therapy in 31.2% of cases and 43.7% in the controls. Tenofovir based therapy was used in 6.2% of cases vs 18.7% in the controls. The commonest causes of death were drug toxicity 19%, advanced Acquired Immunodeficiency Syndrome (AIDS) in 37%, Immune Reconstitution Inflammatory Syndrome (IRIS) in 16%, non AIDS related deaths in 22% and malignancies 6%. In a univariate analysis, absolute lymphocyte count <1200 cells/cmm (p=0.03), development of immune reconstitution inflammatory syndrome (IRIS) (p=0.000) and mean CD4 cell count increase <75 cells/microl after 1 year of ART (p=0.001) were significantly associated with mortality.
  
  
  CONCLUSIONS
  The mortality among our patients was comparable to that reported from other low-income countries. Earlier initiation of ART may reduce the high mortality rates observed.
authors.affiliation: Department of Medicine-I, Infectious Diseases, Training and Research Centre.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Rupali
authors.forename: Sam
authors.initials: S
authors.lastname: Mannam
authors.forename: Annie
authors.initials: A
authors.lastname: Bella
authors.forename: Lydia
authors.initials: L
authors.lastname: John
authors.forename: S
authors.initials: S
authors.lastname: Rajkumar
authors.forename: Peace
authors.initials: P
authors.lastname: Clarence
authors.forename: Susanne A
authors.initials: SA
authors.lastname: Pulimood
authors.forename: Prasanna
authors.initials: P
authors.lastname: Samuel
authors.forename: Rajiv
authors.initials: R
authors.lastname: Karthik
authors.forename: Ooriapadickal Cherian
authors.initials: OC
authors.lastname: Abraham
authors.forename: Dilip
authors.initials: D
authors.lastname: Mathai
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003906:Developing Countries; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000401:mortality*; D007194:India; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents