Africa: HIV Mortality Among HAART Patients in Resource-Poor Settings Can Be Improved

Sub-Saharan Africa's excessive HIV mortality rates could be reduced if patients were diagnosed sooner and placed on highly active antiretroviral therapy earlier in the course of the disease, according to research presented at the 16th Conference on Retroviruses and Opportunistic Infections in Montreal.

The study investigators, Dr. Martin Brinkhof of the University of Berne in Switzerland and colleagues, estimated the two-year mortality rates for HIV patients on HAART in sub-Saharan Africa and compared them with the rates of the uninfected general population. AIDS mortality data were collected for patients receiving HAART in Ivory Coast, Malawi, South Africa, and Zimbabwe. Comparison mortality data for the general population were derived from the World Health Organization's (WHO) Global Burden of Disease project estimates.

The analysis included data on 13,249 patients (67 percent female; median age 34). Clinical stage data were available on 12,720 patients, of whom 10,811 had advanced disease at treatment initiation. In 14,695 person-years of follow-up, 1,177 deaths were recorded.

During the first three months of treatment, patients with advanced HIV disease had mortality rates 400 to 500 times greater than the general population. Those with 200 or more CD4 cells per microliter had mortality rates 20 to 30 times greater than the general population.

Over the two-year period, patients with extreme immunodeficiency had 50 times the mortality rate of the general population. Patients who initiated HAART with 200 or more CD4 cells per microliter had mortality rates three to four times those of the general population. Patients who started treatment with a CD4 count of less than 25 and were at WHO disease stage III/IV had excess mortality of 17.5 per 100 person-years, compared to 1.0 per 100 person-years among those who initiated treatment with a CD4 count of 200 or more and were at WHO disease stage I/II. Excess mortality of 0.29 per 100 person-years was noted for patients who initiated HAART with a CD4 count of 200 or more at WHO disease stage I/II.

"Clearly it is critical that we have to start treating earlier," Brinkof said, though he noted that less than 15 percent of patients access the medications at earlier disease stages.

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