Journal Article

Cause-Specific Mortality and the Contribution of Immune Reconstitution Inflammatory Syndrome in the First 3 Years after Antiretroviral Therapy Initiation in an Urban African Cohort

Barbara Castelnuovo, Yukari C. Manabe, Agnes Kiragga, Moses Kamya, Philippa Easterbrook and Andrew Kambugu

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 6, pages 965-972
Published in print September 2009 | ISSN: 1058-4838
Published online September 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/605500
Cause-Specific Mortality and the Contribution of Immune Reconstitution Inflammatory Syndrome in the First 3 Years after Antiretroviral Therapy Initiation in an Urban African Cohort

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Background.Although many studies have reported high early mortality among patients enrolled in antiretroviral therapy (ART) programs in sub-Saharan Africa—particularly among those individuals with advanced immunodeficiency—few studies have reported the most common causes of these early deaths

Methods.We determined cause-specific mortality and the contribution of immune reconstitution inflammatory syndrome (IRIS) in a well-characterized patient cohort in Kampala, Uganda, over a 36-month period of ART.

Results.In a cohort of patients who initiated antiretroviral therapy in Uganda, we observed a high early mortality rate among patients with advanced disease. The most common causes of death were tuberculosis and cryptococcal meningitis. The contribution of immune reconstitution inflammatory syndrome to mortality was limited.

Conclusions.We show a significant early mortality in our ART cohort in resource-limited settings that is driven by advanced human immunodeficiency virus disease and characterized by low CD4 cell counts. In our experience, the contribution of IRIS to this observed early mortality is limited.

Journal Article.  4368 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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