PMID- 23781664
OWN - NLM
STAT- MEDLINE
DCOM- 20130926
LR  - 20131121
IS  - 0004-5772 (Print)
IS  - 0004-5772 (Linking)
VI  - 60
DP  - 2012 Dec
TI  - Risk factors for mortality in a south Indian population on generic antiretroviral 
      therapy.
PG  - 11-4
AB  - 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.
FAU - Rupali, Priscilla
AU  - Rupali P
AD  - Department of Medicine-I, Infectious Diseases, Training and Research Centre.
FAU - Mannam, Sam
AU  - Mannam S
FAU - Bella, Annie
AU  - Bella A
FAU - John, Lydia
AU  - John L
FAU - Rajkumar, S
AU  - Rajkumar S
FAU - Clarence, Peace
AU  - Clarence P
FAU - Pulimood, Susanne A
AU  - Pulimood SA
FAU - Samuel, Prasanna
AU  - Samuel P
FAU - Karthik, Rajiv
AU  - Karthik R
FAU - Abraham, Ooriapadickal Cherian
AU  - Abraham OC
FAU - Mathai, Dilip
AU  - Mathai D
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Assoc Physicians India
JT  - The Journal of the Association of Physicians of India
JID - 7505585
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/drug therapy/*mortality
MH  - Adult
MH  - Anti-Retroviral Agents/*adverse effects/therapeutic use
MH  - *Developing Countries
MH  - Drug-Related Side Effects and Adverse Reactions/mortality
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*mortality
MH  - India
MH  - Male
MH  - Neoplasms/*mortality
MH  - Risk Factors
EDAT- 2013/06/21 06:00
MHDA- 2013/09/27 06:00
CRDT- 2013/06/21 06:00
PHST- 2013/06/21 06:00 [entrez]
PHST- 2013/06/21 06:00 [pubmed]
PHST- 2013/09/27 06:00 [medline]
PST - ppublish
SO  - J Assoc Physicians India. 2012 Dec;60:11-4.