Life Expectancy of Persons Receiving Combination Antiretroviral Therapy in Low-Income Countries: A Cohort Analysis From Uganda

University of Ottawa, Ottawa, Ontario, Canada.
Annals of internal medicine (Impact Factor: 17.81). 08/2011; 155(4):209-16. DOI: 10.1059/0003-4819-155-4-201108160-00358
Source: PubMed


Little is known about the effect of combination antiretroviral therapy (cART) on life expectancy in sub-Saharan Africa.
To estimate life expectancy of patients once they initiate cART in Uganda.
Prospective cohort study.
Public sector HIV and AIDS disease-management program in Uganda.
22 315 eligible patients initiated cART during the study period, of whom 1943 were considered to have died.
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.
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 × 10(9) 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 × 10(9) 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.
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 × 10(9) cells/L initiated cART.
Ugandan patients receiving cART can expect an almost normal life expectancy, although there is considerable variability among subgroups of patients.
Canadian Institutes of Health Research.

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    • "With the increasing availability of ART and access to early HIV diagnosis, the life expectancy of HIV patients has improved. People living with HIV in Uganda now enjoy the same life expectancy as the general population [5]. With the transformation of HIV into a chronic condition through the immunological effectiveness of the treatment, health-related quality of life (HRQoL) has now become an important focus for HIV care [6]. "
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    ABSTRACT: Ugandans have endured the HIV epidemic for three decades. Now, with the availability of antiretroviral therapy (ART) and early diagnosis, those living with HIV can live longer and can enjoy the same life expectancy as the rest of the Ugandan population. This emerging trend necessitates the assessment of quality of life, alongside other patient outcomes, of those undergoing therapy, alongside other patient outcomes. While major strides have been made in developing measures of quality of life in the developed world, there remains a paucity of evidence from resource-limited settings. This challenge is further complicated by the contentious definition of quality of life, which is highly subjective and varies between individuals. In this paper, we aim to identify the determinants of quality of life for people living with HIV in a Ugandan context to contribute to the chronic care model for persons living with HIV/AIDS. Twenty HIV-positive participants took part in in-depth interviews at an urban clinic, with follow-ups at three and six months. Ten patients were on ART and ten not on ART. All interviews were transcribed and translated for analysis. Data were analysed manually using the framework approach to content analysis. Individuals reported on four aspects of quality of life: liveability of the environment, utility of life, life ability of a person and appreciation of life. Respondents described multiple expectations and expressed hope for their future. However, many still suffered from stigma, fears of disclosure and poverty, which negatively affected their quality of life. Individuals living with HIV receiving treatment or in care experienced an improved quality of life in this setting, although the situation for many remains precarious.
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    • "Consequently, men are more likely than women to die on ART (Cornell et al. 2011; Taylor- Smith et al. 2010; Mills et al. 2009). As Mills et al. (2011: 209 and 214) state, 'After adjustment for loss to follow-up, crude mortality rates (deaths per 1000 person-years) ranged from 26.9… in women to 43.9… in men… This finding builds on an emerging body of literature displaying consistent shortcomings in treatment programs involving men'. These gender discrepancies in ART uptake may reflect men's beliefs, informed by patriarchal ideas of what it means to 'be a man', that seeking health services is a sign of weakness or vulnerability, and that such services are not male-friendly (Nachega et al. 2006). "
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