Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa.Report as inadecuate




Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. - Download this document for free, or read online. Document in PDF available to download.

* Corresponding author 1 The Desmond Tutu HIV Centre Institute of Infectious Disease and Molecular Medicine 2 Clinical research unit 3 HIV unit 4 Family Health International 5 Programme PAC-CI 6 Epidémiologie et Biostatistique Bordeaux 7 Infectious Disease Epidemiology Unit 8 Department of epidemiology

Abstract : Two-thirds of the world-s HIV-infected people live in sub-Saharan Africa, and more than 1.5 million of them die annually. As access to antiretroviral treatment has expanded within the region; early pessimism concerning the delivery of antiretroviral treatment using a large-scale public health approach has, at least in the short term, proved to be broadly unfounded. Immunological and virological responses to ART are similar to responses in patients treated in high-income countries. Despite this, however, early mortality rates in sub-Saharan Africa are very high; between 8 and 26% of patients die in the first year of antiretroviral treatment, with most deaths occurring in the first few months. Patients typically access antiretroviral treatment with advanced symptomatic disease, and mortality is strongly associated with baseline CD4 cell count less than 50 cells-mul and WHO stage 4 disease AIDS. Although data are limited, leading causes of death appear to be tuberculosis, acute sepsis, cryptococcal meningitis, malignancy and wasting syndrome. Mortality rates are likely to depend not only on the care delivered by antiretroviral treatment programmes, but more fundamentally on how advanced disease is at programme enrolment and the quality of preceding healthcare. In addition to improving delivery of antiretroviral treatment and providing it free of charge to the patient, strategies to reduce mortality must include earlier diagnosis of HIV infection, strengthening of longitudinal HIV care and timely initiation of antiretroviral treatment. Health systems delays in antiretroviral treatment initiation must be minimized, especially in patients who present with advanced immunodeficiency.

Keywords : HIV AIDS antiretroviral treatment HAART ART mortality death Africa





Author: Stephen Lawn - Anthony Harries - Xavier Anglaret - Landon Myer - Robin Wood -

Source: https://hal.archives-ouvertes.fr/



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