Early antiretroviral therapy mortality in resource-limited settings: what can we do about it?

Abstract:

PURPOSE OF REVIEW:Highly active antiretroviral therapy has markedly reduced HIV morbidity and mortality in industrialized countries. Expanded access to the 6.5 million individuals in immediate need of antiretroviral therapy using a public-health-systems approach is now promulgated as an international policy. An approximate 1.6 million individuals have already accessed antiretroviral therapy within programs in resource-poor settings. RECENT FINDINGS:Early studies from these treatment programs confirm similar virologic and immunologic responses to antiretroviral therapy as were observed earlier in industrialized settings. While medium-term reductions in morbidity and mortality also parallel those reported from Europe and North America, of particular concern is the observation that mortality immediately after starting antiretroviral therapy in resource-poor settings is several-fold higher than that of similar patients initiating antiretroviral therapy in industrialized settings. SUMMARY:This early mortality is multifactorial and is both a reflection of a very high preantiretroviral therapy mortality and a variety of factors such as comorbid conditions, late presentation, immune restoration disease, together with limited treatment and diagnostic options. Causes of mortality immediately prior to and during early antiretroviral therapy are reviewed and strategies to reduce mortality are identified and discussed.

journal_name

Curr Opin HIV AIDS

authors

Bekker LG,Egger M,Wood R

doi

10.1097/COH.0b013e3281e72cbd

subject

Has Abstract

pub_date

2007-07-01 00:00:00

pages

346-51

issue

4

eissn

1746-630X

issn

1746-6318

pii

01222929-200707000-00017

journal_volume

2

pub_type

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