Academic Journal
Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial
| العنوان: | Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial |
|---|---|
| المؤلفون: | Post, FA, Szubert, AJ, Prendergast, AJ, Johnston, V, Lyall, H, Fitzgerald, F, Musiime, V, Musoro, G, Chepkorir, P, Agutu, C, Mallewa, J, Rajapakse, C, Wilkes, H, Hakim, J, Mugyenyi, P, Walker, AS, GIbb, DM, Pett, SL |
| المصدر: | Clinical Infectious Diseases , 66 (S2) S132-S139. (2018) |
| بيانات النشر: | University of Chicago Press |
| سنة النشر: | 2018 |
| المجموعة: | University College London: UCL Discovery |
| مصطلحات موضوعية: | HIV, Africa, antiretroviral therapy, mortality, morbidity |
| الوصف: | BACKGROUND: In sub-Saharan Africa, 20%-25% of people starting ART have severe immunosuppression; ~10% die within three months. In the recently-reported REALITY randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced all-cause mortality versus cotrimoxazole alone; here, we investigate in detail the contribution and timing of different causes of mortality/morbidity. METHODS: Participants started ART with CD4 <100 cells/mm3; enhanced-prophylaxis comprised cotrimoxazole plus 12 weeks’ isoniazid+fluconazole, single-dose albendazole and 5-days azithromycin. A blinded endpoint review committee adjudicated events and causes of death as (non-mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infections (SBI), other potentially azithromycin-responsive infections, other events, and unknown (deaths only). RESULTS: Median pre-ART CD4 was 37 cells/mm3. 225/1805(12.7%) participants died by week-48. Fatal/non-fatal events occurred early (median 4.0(IQR2.0-11.7) weeks post-ART initiation), then rates declined exponentially. 154 deaths had single and 71 multiple causes, including tuberculosis in 80(4.5%) participants, cryptococcosis 20(1.1%), SBI 33(1.9%), other potentially-azithromycin-responsive infections 23(1.3%), other events 63(3.6%) and unknown 88(5.0%). Enhanced-prophylaxis reduced deaths from cryptococcosis (p=0.03) and unknown causes (p=0.03) but not tuberculosis, SBI, potentially azithromycin-responsive infections or other causes (p>0.3). Enhanced-prophylaxis reduced incidence of non-fatal/fatal tuberculosis (p=0.007) and cryptococcosis (p=0.03), but not SBI, other potentially-azithromycin-responsive infections or other events (p>0.2). By week-48, rates were lowest (<1/100 person-years [PY]) for cryptococcosis, moderate (1-5/100PY) for tuberculosis, SBI, other potentially-azithromycin-responsive events and unknown deaths, and highest (>5/100PY) for other events. CONCLUSIONS: Enhanced-prophylaxis reduced mortality from cryptococcosis and unknown causes and non-fatal ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | text |
| اللغة: | English |
| Relation: | https://discovery.ucl.ac.uk/id/eprint/10040800/25/Post_cix1141.pdf; https://discovery.ucl.ac.uk/id/eprint/10040800/ |
| الاتاحة: | https://discovery.ucl.ac.uk/id/eprint/10040800/25/Post_cix1141.pdf https://discovery.ucl.ac.uk/id/eprint/10040800/ |
| Rights: | open |
| رقم الانضمام: | edsbas.A54E40D3 |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |