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A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?

BACKGROUND: The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients o...

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Autores principales: Kiragga, Agnes N., Mubiru, Frank, Kambugu, Andrew D., Kamya, Moses R., Castelnuovo, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341568/
https://www.ncbi.nlm.nih.gov/pubmed/30665434
http://dx.doi.org/10.1186/s12879-019-3724-x
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author Kiragga, Agnes N.
Mubiru, Frank
Kambugu, Andrew D.
Kamya, Moses R.
Castelnuovo, Barbara
author_facet Kiragga, Agnes N.
Mubiru, Frank
Kambugu, Andrew D.
Kamya, Moses R.
Castelnuovo, Barbara
author_sort Kiragga, Agnes N.
collection PubMed
description BACKGROUND: The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa. METHODS: We used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death. RESULTS: Of the 559, (386, 69%) were female, median age 36 years (IQR: 21–44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/μL (IQR: 21–163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi’s Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%). CONCLUSION: Despite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-3724-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-63415682019-01-24 A decade of antiretroviral therapy in Uganda: what are the emerging causes of death? Kiragga, Agnes N. Mubiru, Frank Kambugu, Andrew D. Kamya, Moses R. Castelnuovo, Barbara BMC Infect Dis Research Article BACKGROUND: The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa. METHODS: We used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death. RESULTS: Of the 559, (386, 69%) were female, median age 36 years (IQR: 21–44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/μL (IQR: 21–163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi’s Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%). CONCLUSION: Despite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-3724-x) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-21 /pmc/articles/PMC6341568/ /pubmed/30665434 http://dx.doi.org/10.1186/s12879-019-3724-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kiragga, Agnes N.
Mubiru, Frank
Kambugu, Andrew D.
Kamya, Moses R.
Castelnuovo, Barbara
A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title_full A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title_fullStr A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title_full_unstemmed A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title_short A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
title_sort decade of antiretroviral therapy in uganda: what are the emerging causes of death?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341568/
https://www.ncbi.nlm.nih.gov/pubmed/30665434
http://dx.doi.org/10.1186/s12879-019-3724-x
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