Starting HAART Earlier Might Reduce Mortality Rates, Study Says
Earlier detection of HIV and initiation of highly active antiretroviral therapy might help reduce high mortality rates in sub-Saharan Africa, according to a study recently presented at the 16th Conference on Retroviruses and Opportunistic Infections in Montreal, Canada, Reuters reports. Martin Brinkhof of the University of Berne, who led the study, said that very high mortality rates in sub-Saharan Africa have "substantially declined" since the introduction of HAART, "but what remains unclear is to what extent this reduction in mortality approaches the levels seen in the general population."
Brinkhof and colleagues collected data on two-year mortality rates among HIV-positive people taking HAART in Cote d'Ivoire, Malawi, South Africa and Zimbabwe. The data were then compared with the expected number of deaths in the HIV-negative general population. The data for the general population were based on estimates from the World Health Organization's Global Burden of Disease project, which examined sex, age, country and mortality data unrelated to HIV. According to Reuters, data on 13,249 HIV-positive people were included, with women representing 67% of the participants. The participants had a median age of 34. Data on clinical stage were available for 12,720 people, and 10,811 had progressed to advanced stages of HIV when they began HAART. There were 1,177 deaths over 14,695 person-years of follow-up.
According to Brinkhof, the study found that people with extremely advanced HIV had mortality rates 400 to 500 times greater than the general population over the first three months of treatment. The researchers also found that even those with CD4+ T cell counts of 200 or more had mortality rates 20 to 30 times higher than the general population during the first three months. In addition, people who began HAART with extreme immunodeficiency had 50 times the mortality rate of the general population over the first two years of treatment, and the rates were three to four times greater for people who started treatment with T cell counts of 200 or higher.
Among patients who started treatment with T cell counts of less than 25 and WHO stage III/IV disease, the excess mortality was 17.5 per 100 person-years. This compares with 1.0 per 100 person-years among those who started treatments with a T cell count of at least 200 and WHO stage I/II disease. An excess mortality of 0.29 per 100 person-years was recorded among patients who began treatment with T cell counts of 200 or greater and WHO stage I/II disease and were alive one year later. Brinkhof said that "clearly it is critical that we have to start treating earlier" because very few patients -- less than 15% -- begin treatment with higher T cell counts and less advanced stages of the disease (Reuters, 2/9).