TY - JOUR
T1 - Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America
T2 - A Collaborative Analysis of Prospective Studies
AU - Boulle, Andrew
AU - Schomaker, Michael
AU - May, Margaret T.
AU - Hogg, Robert S.
AU - Shepherd, Bryan E.
AU - Monge, Susana
AU - Keiser, Olivia
AU - Lampe, Fiona C.
AU - Giddy, Janet
AU - Ndirangu, James
AU - Garone, Daniela
AU - Fox, Matthew
AU - Ingle, Suzanne M.
AU - Reiss, Peter
AU - Dabis, Francois
AU - Costagliola, Dominique
AU - Castagna, Antonella
AU - Ehren, Kathrin
AU - Campbell, Colin
AU - Gill, M. John
AU - Saag, Michael
AU - Justice, Amy C.
AU - Guest, Jodie
AU - Crane, Heidi M.
AU - Egger, Matthias
AU - Sterne, Jonathan A C
PY - 2014/9/1
Y1 - 2014/9/1
N2 - After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts.Please see later in the article for the Editors' Summary.High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America.Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0–3, 3–6, 6–12, 12–24, and 24–48 months on ART for the period 2001–2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count
AB - After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts.Please see later in the article for the Editors' Summary.High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America.Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0–3, 3–6, 6–12, 12–24, and 24–48 months on ART for the period 2001–2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count
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U2 - 10.1371/journal.pmed.1001718
DO - 10.1371/journal.pmed.1001718
M3 - Article
C2 - 25203931
AN - SCOPUS:84907961908
VL - 11
JO - PLoS Medicine
JF - PLoS Medicine
SN - 1549-1277
IS - 9
ER -