AF7 Early Post-Anti-Retroviral Therapy Associated Mortality: Is it a Significant Problem That is Worthy Exploring? The Experience of AIDSRelief Tanzania.

Komba, P.; Msaki, A.; Maghimbi, A.
JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/01.qai.0000413727.76491.a9

Background: Recent studies have demonstrated a higher "early" mortality rate in adults receiving ART in low income countries as compared to those of high-income-even after accounting for baseline immunodeficiency. AIDS Relief QI program conducted this survey to gain insight on how best to improve the HIV programme and consequently reduce mortality.

Methods: A cross sectional mini-survey was done in (Ngudu, Misungwi, Sumve and Nyamagana hospitals) in Mwanza Region (using charts review). A convenient sample of 278 case notes of deceased HIV/AIDS patients who died between years 2006 and 2010 was selected. Only data for 118 patients with complete information was used for analysis.

Results: The median age for the deceased patients was 38 years (IQR; 31-47). Majority of patients were WHO clinical stage 3 and 4 (32.2% and 54.8% respectively), and the median CD4 count at baseline was 47 mL (IQR; 18-124). One-fifth (19.7%) of the deaths occurred by the second week of starting ARTs, ie, before the 2 weeks evaluation visit. Another 20% patients died in the third and fourth week of starting ART, and by the 6th month more than three quarters (80%) of all patients on ART had died. TB was diagnosed in only 1/19 (5%) of deaths that occurred in the first two weeks post-ARTs, and 4/24 (17%) patients who died on the third and fourth week had a clinical diagnosis of TB (P = 0.08).

Conclusion: Mortality amongst patients started on ARTs seem to be alarmingly higher compared to data reported elsewhere. Clinicians need to do more vigorous and close monitoring of patients before starting them on ARTs for better outcomes. There is a need to do more systematic studies to explore early mortality in detail.

(C) 2012 Lippincott Williams & Wilkins, Inc.