Antiretroviral therapy is finally reaching millions of persons with HIV infection in Africa. While countless lives have been saved, it is becoming increasingly clear that deaths in the first 6 months on ART are dramatically elevated as compared to industrialized settings, - perhaps claiming as many as five-fold more than in industrialized settings. Even these alarming estimates, however, are likely underestimates because high losses to follow up in resource limited settings mean that many deaths are not ascertained. The causes of these early deaths, furthermore, are not well explained. Therefore the proposed Aims seek to (1) evaluate a sampling-based technique that we have developed to understand the true magnitude of early mortality;(2) determine whether undiagnosed opportunistic infections are the cause of early mortality on ART by collecting biological specimens and investigating them intensively in San Francisco and (3) develop a clinical prediction rule to risk stratify individual patients for early mortality at the time or ART initiation. Overall, this study seeks to understand the magnitude and determinants of early mortality on ART in HIV infected patients in Africa in order to develop a targeted intervention in the future to reduce it.
These Aims will also provide a platform for completing further career development toward independence as a scientist.

Public Health Relevance

Early mortality on ART may claim 1 in 10 patients of the millions of patients starting ART in Africa. These deaths are likely due to treatable infections. Therefore, a better understanding of early mortality on ART in Africa has the potential to improve ART delivery and save many lives.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
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Mckaig, Rosemary G
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Camlin, Carol S; Neilands, Torsten B; Odeny, Thomas A et al. (2016) Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa. AIDS 30:495-502
Reidy, William; Agarwal, Mansi; Chege, Duncan et al. (2016) Retention in Care Among HIV-infected Patients Receiving or Not Receiving Antiretroviral Therapy in Eastern Africa. Clin Infect Dis 63:426-7
Geng, Elvin H; Odeny, Thomas A; Lyamuya, Rita et al. (2016) Retention in Care and Patient-Reported Reasons for Undocumented Transfer or Stopping Care Among HIV-Infected Patients on Antiretroviral Therapy in Eastern Africa: Application of a Sampling-Based Approach. Clin Infect Dis 62:935-944
Garner, Will; White, Kirsten; Szwarcberg, Javier et al. (2016) Concordance of HIV-1 RNA Values by Amplicor and TaqMan 2.0 in Patients With Confirmed Suppression in Clinical Trials. Clin Infect Dis 62:929-934
Geng, Elvin H; Neilands, Torsten B; Thi├Ębaut, Rodolphe et al. (2015) CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa. Int J Epidemiol 44:251-63
Petersen, Maya L; Tran, Linh; Geng, Elvin H et al. (2014) Delayed switch of antiretroviral therapy after virologic failure associated with elevated mortality among HIV-infected adults in Africa. AIDS 28:2097-107
Vijayan, Tara; Semitala, Fred C; Matsiko, Nicholas et al. (2013) Changes in the timing of antiretroviral therapy initiation in HIV-infected patients with tuberculosis in Uganda: a study of the diffusion of evidence into practice in the global response to HIV/AIDS. Clin Infect Dis 57:1766-72
Namusobya, Jennifer; Semitala, Fred C; Amanyire, Gideon et al. (2013) High retention in care among HIV-infected patients entering care with CD4 levels >350 cells/?L under routine program conditions in Uganda. Clin Infect Dis 57:1343-50
Geng, Elvin H; Bwana, Mwebesa B; Muyindike, Winnie et al. (2013) Failure to initiate antiretroviral therapy, loss to follow-up and mortality among HIV-infected patients during the pre-ART period in Uganda. J Acquir Immune Defic Syndr 63:e64-71
Lamb, Matthew R; El-Sadr, Wafaa M; Geng, Elvin et al. (2012) Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa. PLoS One 7:e38443

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