Life Expectancy of Persons Receiving Combination Antiretroviral Therapy in Low-Income Countries: A Cohort Analysis From Uganda
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Annals of internal medicine
Abstract
Little is known about the effect of combination antiretroviral
therapy (cART) on life expectancy in sub-Saharan Africa.
Objective: To estimate life expectancy of patients once they initiate
cART in Uganda.
Design: Prospective cohort study.
Setting: Public sector HIV and AIDS disease-management program
in Uganda.
Patients: 22 315 eligible patients initiated cART during the study
period, of whom 1943 were considered to have died.
Measurements: All-cause mortality rates were calculated and
abridged life tables were constructed and stratified by sex and
baseline CD4 cell count status to estimate life expectancies for
patients receiving cART. The average number of years remaining to
be lived by patients who received cART at varying age categories
was estimated.
Results: After adjustment for loss to follow-up, crude mortality
rates (deaths per 1000 person-years) ranged from 26.9 (95% CI,
25.4 to 28.5) in women to 43.9 (CI, 40.7 to 47.0) in men. For
patients with a baseline CD4 cell count less than 0.050 109
cells/L, the mortality rate was 67.3 (CI, 62.1 to 72.9) deaths per
1000 person-years, whereas among persons with a baseline CD4
cell count of 0.250 109 cells/L or more, the mortality rate was
19.1 (CI, 16.0 to 22.7) deaths per 1000 person-years. Life expectancy
at age 20 years for the overall cohort was 26.7 (CI, 25.0 to
28.4) additional years and at age 35 years was 27.9 (CI, 26.7 to
29.1) additional years. Life expectancy increased substantially with
increasing baseline CD4 cell count. Similar trends are observed for
older age groups.
Limitations: A small (6.4%) proportion of patients were lost to
follow-up, and it was imputed that 30% of these patients had died.
Few patients with a CD4 cell count greater than 0.250 109
cells/L initiated cART.
Conclusion: Ugandan patients receiving cART can expect an almost
normal life expectancy, although there is considerable variability
among subgroups of patients.
Description
Keywords
Life Expectancy, Antiretroviral Therapy, Low-Income Countries, Uganda
Citation
Mills, E. J., Bakanda, C., Birungi, J., Chan, K., Ford, N., Cooper, C. L., ... & Hogg, R. S. (2011). Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Annals of internal medicine, 155(4), 209-216.