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http://ir.mu.ac.ke:8080/jspui/handle/123456789/7885
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DC Field | Value | Language |
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dc.contributor.author | Post, Frank A. | - |
dc.contributor.author | Szubert, Alexander J. | - |
dc.contributor.author | Prendergast, Andrew J. | - |
dc.contributor.author | Johnston, Victoria | - |
dc.contributor.author | Lyall, Hermione | - |
dc.contributor.author | Fitzgerald, Felicity | - |
dc.contributor.author | Musoro, Godfrey | - |
dc.contributor.author | Musiime, Victor | - |
dc.contributor.author | Chepkorir, Priscilla | - |
dc.contributor.author | Agutu, Clara | - |
dc.contributor.author | Mallewa, Jane | - |
dc.contributor.author | Rajapakse, Chathurika | - |
dc.contributor.author | Wilkes, Helen | - |
dc.contributor.author | Hakim, James | - |
dc.contributor.author | Mugyenyi, Peter | - |
dc.contributor.author | Walker, Sarah | - |
dc.contributor.author | Gibb, Diana M. | - |
dc.contributor.author | Pett, Sarah L. | - |
dc.date.accessioned | 2023-07-27T07:51:51Z | - |
dc.date.available | 2023-07-27T07:51:51Z | - |
dc.date.issued | 2018 | - |
dc.identifier.uri | http://ir.mu.ac.ke:8080/jspui/handle/123456789/7885 | - |
dc.description.abstract | Background. In sub-Saharan Africa, 20%–25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity. Methods. Participants started ART with a CD4 count <100 cells/μL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non–mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azith- romycin-responsive infections, other events, and unknown. Results. Median pre-ART CD4 count was 37 cells/μL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-re- sponsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2). Conclusions. Enhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease. | en_US |
dc.language.iso | en | en_US |
dc.publisher | Oxford University Press | en_US |
dc.subject | HIV | en_US |
dc.subject | Antiretroviral therapy | en_US |
dc.subject | Mortality | en_US |
dc.subject | Morbidity | en_US |
dc.title | Causes and timing of mortality and morbidity among late presenters starting Antiretroviral therapy in the REALITY Trial | en_US |
dc.type | Article | en_US |
Appears in Collections: | School of Medicine |
Files in This Item:
File | Description | Size | Format | |
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CHEPKORIR.pdf | 548 kB | Adobe PDF | View/Open |
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