Kibuuka et al reported predictors of mortality for an HIV-positive patient in sub-Saharan Africa. These can help to identify a patient who may benefit from more aggressive management. The authors are from Makerere University, Walter Reed Army Institute of Research, and other research organizations participating in the AFRICOS Study Group,
Patient selection: HIV positive
Countries include: Uganda, Nigeria, Tanzania, Kenya
Causes of death:
(1) malignancy (28%)
(2) infection (30%)
(3) non-HIV related conditions
Predictors of mortality:
(1) CD4-positive lymphocyte count <= 350 cells per microliter (aHR 2.0)
(2) a LOG10[(RNA HIV copies)/mL] increase in viral load (aHR 1.36)
(3) history of fever in the past 6 months (aHR 1.85)
(4) body mass index < 18.5 kg per sq m (aHR 2.2)
(5) clinical depression (aHR 2.4)
(6) WHO stage III (aHR 2.2), based on WHO Stage I to IV
(7) a 1 g/dL increase in hemoglobin (aHR 0.79)
(8) every year on antiretroviral therapy (aHR 0.67)
(9) any immediate family member diagnosed with HIV (aHR 2.3)
(10) infections (aHR 1.77)
Viral suppression with immune reconstitution are important goals to reduce mortality.
