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Preliminary Analysis of Mortality and Causes of Death Among the First ARV-Tretment Naive HIV-1C Infected Persons Receiving HAART in the Public Sector at Princess Marina Hospital Tendani Gaolathe 1, Ndwapi Ndwapi 1, Ava Avalos2 , Didi Motsepe 1, William Wester 2, Hermann Bussmann2, Juergen Freers4 , Howard Moffat 1, Trevor Peter 2 , Chris Vanderwarker 2, Max Essex 2,3 and Richard Marlink2,3 1Infectious Disease Care Clinic; Princess Marina Hospital, Gaborone, Botswana, 2Botswana-Harvard Partnership for HIV Research and Education, 3Harvard School of Public Health,Department of Immunology and Infectious Disease, Boston, Massachusetts.4 Makerere University, Kampala Uganda 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 at one site in the program. 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: Morality: 33 of 306 (10.7%) patients died during the study period. Baseline characteristics: Females 72% and males 38%. Mean age 32.9 yrs (range 20-48 yrs); 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) 514 303 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 anemia 12.1%; NVP induced hepatitis 3%; Cryptoccocal meningitis 9%; TB meningitis 6%; Kaposi’s Sarcoma 9%; PCP 3%; pseudomonas pneumonia 3%; anemia (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 anemia 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. |