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Predictors of mortality within the first year of initiating antiretroviral therapy in urban and rural Kenya: A prospective cohort study

Author

Listed:
  • Rachel A Silverman
  • Grace C John-Stewart
  • Ingrid A Beck
  • Ross Milne
  • Catherine Kiptinness
  • Christine J McGrath
  • Barbra A Richardson
  • Bhavna Chohan
  • Samah R Sakr
  • Lisa M Frenkel
  • Michael H Chung

Abstract

Introduction: Despite increased treatment availability, HIV-infected individuals continue to start antiretroviral therapy (ART) late in disease progression, increasing early mortality risk. Materials and methods: Nested prospective cohort study within a randomized clinical trial of adult patients initiating ART at clinics in urban Nairobi and rural Maseno, Kenya, between 2013–2014. We estimated mortality incidence rates following ART initiation and used Cox proportional hazards regression to identify predictors of mortality within 12 months of ART initiation. Analyses were stratified by clinic site to examine differences in mortality correlates and risk by location. Results: Among 811 participants initiated on ART, the mortality incidence rate within a year of initiating ART was 7.44 per 100 person-years (95% CI 5.71, 9.69). Among 207 Maseno and 612 Nairobi participants initiated on ART, the mortality incidence rates (per 100 person-years) were 12.78 (95% CI 8.49, 19.23) and 5.72 (95% CI 4.05, 8.09). Maseno had a 2.20-fold greater risk of mortality than Nairobi (95% CI 1.29, 3.76; P = 0.004). This association remained [adjusted hazard ratio (HR) = 2.09 (95% CI 1.17, 3.74); P = 0.013] when adjusting for age, gender, education, pre-treatment drug resistance (PDR), and CD4 count, but not when adjusting for BMI. In unadjusted analyses, other predictors (P

Suggested Citation

  • Rachel A Silverman & Grace C John-Stewart & Ingrid A Beck & Ross Milne & Catherine Kiptinness & Christine J McGrath & Barbra A Richardson & Bhavna Chohan & Samah R Sakr & Lisa M Frenkel & Michael H Ch, 2019. "Predictors of mortality within the first year of initiating antiretroviral therapy in urban and rural Kenya: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-19, October.
    • Handle: RePEc:plo:pone00:0223411
    DOI: 10.1371/journal.pone.0223411
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    2. Amita Gupta & Girish Nadkarni & Wei-Teng Yang & Aditya Chandrasekhar & Nikhil Gupte & Gregory P Bisson & Mina Hosseinipour & Naveen Gummadi, 2011. "Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-11, December.
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