Mortality and treatment failure among HIV-infected adults in Dar Es Salaam, Tanzania.

OBJECTIVES: Monitoring antiretroviral treatment (ART) outcomes is essential for assessing the success of HIV care and treatment programs in resource-limited settings (RLS).

METHODS: Longitudinal analyses of clinical and immunologic parameters in HIV-infected adults initiated on ART between November 2004 and June 2008 at Management and Development for Health (MDH)-Presidents Emergency Plan For AIDS Relief PEPFAR supported HIV care and treatment clinics in Tanzania.

RESULTS: A total of 12 842 patients were analyzed (65.9% female, median baseline CD4 count, 106 cells/mm(3)). Significant improvements in immunologic status were observed with an increase in CD4 count to 298 (interquartile range [IQR] 199-416), 372 (256-490) and 427 (314-580) cells/mm(3), at 1, 2, and 3 years, respectively. Overall mortality was 13.1% (1682 of 12 842). Male sex, World Health Organization (WHO) stage III/IV, CD4 <200 cells/mm(3), hemoglobin (Hgb) <8.5 g/dL, and stavudine (d4T)-containing regimens were independently associated with early and overall mortality.

CONCLUSIONS: Closer monitoring of males and patients with advanced HIV disease following ART initiation may improve clinical and immunologic outcomes in these individuals.