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Cited by 250HIV/AIDS Research and InterventionsHIV-related health complications and treatmentsHIV/AIDS drug development and treatment

Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes

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May, Margaret, Boulle, Andrew, Phiri, Sam, Messou, Eugene, Myer, Landon, Wood, Robin, Keiser, Olivia, Sterne, Jonathan AC +2 more·2010·The Lancet
DOI 10.1016/s0140-6736(10)60666-6PMC PMC3138328
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Abstract

Background Prognostic models have been developed for patients infected with HIV-1 who start combination antiretroviral therapy (ART) in high-income countries, but not for patients in sub-Saharan Africa. We developed two prognostic models to estimate the probability of death in patients starting ART in sub-Saharan Africa.Methods We analysed data for adult patients who started ART in four scale-up programmes in Côte d'Ivoire, South Africa, and Malawi from 2004 to 2007. Patients lost to follow-up in the first year were excluded. We used Weibull survival models to construct two prognostic models: one with CD4 cell count, clinical stage, bodyweight, age, and sex (CD4 count model); and one that replaced CD4 cell count with total lymphocyte count and severity of anaemia (total lymphocyte and haemoglobin model), because CD4 cell count is not routinely measured in many African ART programmes. Death from all causes in the first year of ART was the primary outcome.Findings 912 (8.2%) of 11 153 patients died in the first year of ART. 822 patients were lost to follow-up and not included in the main analysis; 10 331 patients were analysed. Mortality was strongly associated with high baseline CD4 cell count (>/=200 cells per muL vs <25; adjusted hazard ratio 0.21, 95% CI 0.17-0.27), WHO clinical stage (stages III-IV vs I-II; 3.45, 2.43-4.90), bodyweight (>/=60 kg vs <45 kg; 0.23, 0.18-0.30), and anaemia status (none vs severe: 0.27, 0.20-0.36). Other independent risk factors for mortality were low total lymphocyte count, advanced age, and male sex. Probability of death at 1 year ranged from 0.9% (95% CI 0.6-1.4) to 52.5% (43.8-61.7) with the CD4 model, and from 0.9% (0.5-1.4) to 59.6% (48.2-71.4) with the total lymphocyte and haemoglobin model. Both models accurately predict early mortality in patients starting ART in sub-Saharan Africa compared with observed data.Interpretation Prognostic models should be used to counsel patients, plan health services, and predict outcomes for patients with HIV-1 infection in sub-Saharan Africa.Funding US National Institute of Allergy And Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Cancer Institute.

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  • Prediction models for patients with HIV were developed based on data from treatment programmes in Côte d'Ivoire, South Africa, and Malawi and validated using leave-one-country-out cross validation.

    “For example, prediction models for patients with HIV were developed based on data from treatment programmes in Côte d’Ivoire, South Africa, and Malawi and validated using leave-one-country-out cross validation.97”

    From Developing clinical prediction models: a step-by-step guide (2024) · cites this paper as [97]

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Authors
May, M., Boulle, A., Phiri, S., Messou, E., Myer, L., Wood, R., Keiser, O., Sterne, J. A., Dabis, F., & Egger, M.
Affiliations
  • University of Bristol (GB)
  • University of Cape Town (ZA)
  • Kamuzu Central Hospital (MW)
  • University of Bern (CH)
Corresponding author
Egger, Matthias
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2010-08
Volume
376
Issue
9739
Pages
449-457
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(10)60666-6
PMC
PMC3138328
OpenAlex
W2135206837
Cited by
250
References
34
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 15 · 2019: 8 · 2018: 7 · 2017: 13 · 2016: 35 · 2015: 21 · 2014: 28 · 2013: 27 · 2012: 33
FWCI
19.29
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
Funders
  • Agence Nationale de la Recherche
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
  • Agence Nationale de Recherches sur le Sida et les Hépatites Virales
  • National Institutes of Health
  • Medical Research Council
  • National Institute of Allergy and Infectious Diseases (U01AI069919, U01AI069924)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords
HIV-1 infection, antiretroviral therapy, mortality prediction, prognostic model, CD4 count, total lymphocyte count, anemia, WHO clinical stage, body weight, sub-Saharan Africa, first-year mortality, mortality risk factors, Côte d'Ivoire, South Africa, Malawi, Weibull survival model, loss to follow-up
MeSH terms
Adolescent, Adult, Developing Countries, Female, Humans, Male, Middle Aged, Prognosis, Models, Statistical, HIV-1, HIV Infections, Survival Rate, Africa South of the Sahara, Viral Load, Anti-Retroviral Agents, Young Adult

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