title: Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study.
abstract: OBJECTIVE
  Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon.
  
  
  METHODS
  Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012.
  
  
  METHODS
  The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon.
  
  
  METHODS
  People living with HIV infection who started ART between 2007 and 2008 at the study centre.
  
  
  METHODS
  All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up.
  
  
  RESULTS
  Of the 1444 patients included, 827 (53.7%) were men, and the median age (25-75th centiles) was 38 (31-45) years. The median duration of follow-up was 14.1 (1.1-46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III-IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm(3) lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower).
  
  
  CONCLUSIONS
  Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.
authors.affiliation: Pneumology Service, Yaounde Jamot Hospital, Yaounde, Cameroon.
authors.forename: Virginie
authors.initials: V
authors.lastname: Poka-Mayap
authors.forename: Eric Walter
authors.initials: EW
authors.lastname: Pefura-Yone
authors.forename: André Pascal
authors.initials: AP
authors.lastname: Kengne
authors.forename: Christopher
authors.initials: C
authors.lastname: Kuaban
keywords: EPIDEMIOLOGY