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Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial

2018; Oxford University Press; Volume: 66; Issue: suppl_2 Linguagem: Inglês

10.1093/cid/cix1142

1537-6591

Abraham Siika, Leanne McCabe, Mutsa Bwakura‐Dangarembizi, Cissy Kityo, Jane Mallewa, J Berkley, Kathryn Maitland, Anna Griffiths, Keith Baleeta, Shepherd Mudzingwa, James Abach, Kusum Nathoo, Margaret J. Thomason, Andrew J. Prendergast, A. Sarah Walker, Diana M. Gibb, Peter Mugyenyi, Cissy Kityo, Victor Musiime, Priscilla Wavamunno, E. Nambi, Paul Ocitti, Milly Ndigendawani, M Kemigisa, J Acen, David Francis Olebo, Gordon Mpamize, A Amone, David Okweny, A Mbonye, Florence Nambaziira, A Rweyora, M Kangah, V Kabaswahili, James Abach, George Abongomera, J Omongin, I Aciro, A Philliam, B Arach, E Ocung, G Amone, P Miles, Claudia Adong, Constance Tumsuiime, P Kidega, B Otto, Florence Apio, Keith Baleeta, A Mukuye, M Abwola, F Ssennono, David Baliruno, S Tuhirwe, R Namisi, Fredrick Kigongo, Dickson Kikyonkyo, Furaha Mushahara, David Okweny, Julian Tusiime, Alex K. Musiime, A Nankya, Dickens Atwongyeire, Sowal Sirikye, Soumyaditya Mula, Nelson Noowe, Abbas Lugemwa, Mariam Kasozi, Sandra Mwebe, Lorna Atwine, Tapson Senkindu, T Natuhurira, C Katemba, E Ninsiima, M Acaku, Joy Kyomuhangi, Rogers Ankunda, Deogratious Tukwasibwe, Lillian Ayesiga, James Hakim, Kusum Nathoo, Mutsa Bwakura‐Dangarembizi, Andrew Reid, Ennie Chidziva, T Mhute, G Tinago, Joyline Bhiri, Shepherd Mudzingwa, M Phiri, John Steamer, R Nhema, C Warambwa, Godfrey Musoro, S Mutsai, Beauty Nemasango, Crispin Moyo, S Chitongo, Kennias Rashirai, Sydney Vhembo, Brian Mlambo, Sanele Nkomani, B Ndemera, Μ. D. Willard, Chipo Berejena, Y Musodza, Patience Matiza, Boniface Mudenge, Vongai Guti, Anthony Etyang, Clara Agutu, J Berkley, Kathryn Maitland, Patricia Njuguna, Shalton Mwaringa, Anthony Etyang, Ken Awuondo, S. Wale, Jimmy Shangala, Jefwa Kithunga, Salim Mwarumba, Salma Said Maitha, Rancy C. Mutai, Margaret Lozi Lewa, Gabriel Mwambingu, Alfred Mwanzu, Connie Kalama, Helen Ann Latham, Joyce Shikuku, Amos Fondo, A. R. Njogu, Connie Khadenge, Bryan Mwakisha, Abraham Siika, Kara Wools‐Kaloustian, Winston M. Nyandiko, P Cheruiyot, Allan Sudoi, S Wachira, Betty Meli, Mercy Karoney, A Nzioka, M Tanui, M Mokaya, W Lokitala Ekiru, Chris Mboya, Dorothy Mwimali, Cecilia Mengich, Julie Choge, Wilfred Emonyi, Kennedy Njenga, Salinah Cherutich, Millicent Orido, Gerald O. Lwande, Peter Rutto, A Mudogo, Irene Kutto, Amina Shali, Linda Jaika, Hellen Jerotich, M Pierre, Jane Mallewa, Symon Kaunda, Joep van Oosterhout, Bernadette O’Hare, Robert Heydermann, C. Gonzalez, Nettie Dzabala, Christine Kelly, Bruno Denis, George Selemani, Linda Mipando, Esnat Chirwa, Prathibha Banda, Linley Mvula, Harrison Msuku, Milton Ziwoya, Yugandhar Manda, Susanne B. Nicholas, Clemens Masesa, T Mwalukomo, Lumbani Makhaza, Irene Sheha, Joseph Bwanali, Molly Limbuni, Diana M. Gibb, Margaret J. Thomason, AS Walker, Sarah Pett, Alexander J. Szubert, Anna Griffiths, H Wilkes, C Rajapakse, Moira J. Spyer, Andrew J. Prendergast, Nigel Klein, Nadine Van Looy, E Little, Keith Fairbrother, Frances M. Cowan, Janet Seeley, Sarah Bernays, Rachel Kawuma, Zivai Mupambireyi, F Kyomuhendo, S Nakalanzi, J Peshu, S Ndaa, J Chabuka, NC Mkandawire, L Matandika, C Kapuya, Ian Weller, E Malianga, Charles Mwansambo, F Miiro, P Elyanu, Elizabeth A. Bukusi, Elly Katabira, Owen Mugurungi, Diana M. Gibb, James Hakim, Anthony Etyang, Peter Mugyenyi, Jane Mallewa, Tünde Pető, Philippa Musoke, Jonathan Matenga, Sam Phiri, Hermione Lyall, Victoria Johnston, Felicity Fitzgerald, Frank A. Post, Francis Ssali, Andrew J. Prendergast, Alejandro Arenas‐Pinto, Anna Turkova, Alasdair Bamford,

HIV-related health complications and treatments

Severely immunocompromised human immunodeficiency virus (HIV)–infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts .1). Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%–6% mortality. Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. ISRCTN43622374.