[1212] PRELIMINARY ANALYSIS OF MORTALITY AND CAUSES OF DEATH AMONG THE FIRST ARV-TREATMENT NAIVE HIV-1C-INFECTED PERSONS RECEIVING HAART UNDER THE BOTSWANA NATIONAL ARV TREATMENT PROGRAM

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] PRELIMINARY ANALYSIS OF MORTALITY AND CAUSES OF DEATH AMONG THE FIRST ARV-TREATMENT NAÏVE HIV-1C-INFECTED PERSONS RECEIVING HAART UNDER THE BOTSWANA NATIONAL ARV TREATMENT PROGRAM

[AUTHOR(S):] N Ndwapi¹, T Gaolathe¹, A Avalos³, D Motsepe¹, W Wester³, H Bussmann³, J Freers⁴, H Moffat¹, T Peter³, C Vanderwalker³, M Essex^3,4 and R Marlink^3,4
¹Infectious Disease Care Clinic, Princess Marina Hospital, Gaborone, Botswana; ²University of Pennsylvania, USA; ³Botswana-Harvard Partnership for HIV Research and Education; ⁴Harvard School of Public Health, Department of Immunology and Infectious Disease, Boston, MA, USA; and ⁵Makerere University, Kampala, Uganda

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 1212
Antiviral Therapy 2003; 8(Suppl. 1):S527

[ABSTRACT:] Background: The Botswana national ARV treatment program began on January 21, 2002 at Princess Marina Hospital (PMH) in Gaborone. We present preliminary data on the incidence of mortality and causes of death for the first 306 treatment-naïve HIV-1C persons receiving HAART per the Botswana national treatment guidelines.

Methods: Preliminary results from a retrospective chart review analysis for patients initiated on HAART at the Infectious Disease Care Clinic at PMH from January 21, 2002 to June 10, 2002, with an average of 9 months follow-up ending on February 28, 2003.

Results: Mortality: 33 of 306 (10.7%) patients died during the study period. Baseline characteristics: Females 72% and males 38%; mean age 32.9 years (range 20–48 years); mean baseline CD4 value 60 cells/ml (range <1 to 382) with 66% of patients initiated at CD4 values <50; mean viral load value (VL, Roche Amplicor Version 1.5) 514303 copies/ml. Treatment regimens: CBV/NVP 55%; CBV/EFV 39%; DDI/D4T/EFV 6%. Average months on treatment before death: 2.4 months. Causes of mortality (n=33): Wasting with chronic diarrhea 21.2%; wasting without chronic diarrhea 9%; pulmonary TB 18.1%; AZT-induced anaemia 12.1%; NVP-induced hepatitis 3%; cryptoccocal meningitis 9%; TB meningitis 6%; Kaposi's sarcoma 9%; PCP 3%; pseudomonas pneumonia 3%; anaemia (non-AZT-related) 3%; suicide 3%. Lost to follow-up: 8.49% (defined as no patient contact for 2 months after treatment initiation).

Conclusions: Preliminary data indicate that significant mortality of HIV-1C-infected persons receiving HAART is due to wasting syndrome both with and without chronic diarrhea. Research efforts directed at more effective treatment options for patients suffering from wasting syndrome will prove beneficial. Mortality rates of AZT-induced anaemia can also reflect inadequate blood supply for transfusion. Measures to enhance blood banking for necessary transfusions in developing countries will greatly reduce AZT-associated deaths.

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