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)
Project #
Application #
Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Mckaig, Rosemary G
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
Zip Code
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
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
Geng, Elvin H; Glidden, David V; Bangsberg, David R et al. (2012) A causal framework for understanding the effect of losses to follow-up on epidemiologic analyses in clinic-based cohorts: the case of HIV-infected patients on antiretroviral therapy in Africa. Am J Epidemiol 175:1080-7
Geng, Elvin H; Hunt, Peter W; Diero, Lameck O et al. (2011) Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009. J Int AIDS Soc 14:46
Geng, Elvin H; Kahn, James S; Chang, Olivia C et al. (2011) The effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation. Clin Infect Dis 53:1008-14
Geng, Elvin H; Glidden, David V; Bwana, Mwebesa Bosco et al. (2011) Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: estimation via a sampling-based approach. PLoS One 6:e21797
Geng, Elvin H; Bwana, Mwebesa B; Kabakyenga, Jerome et al. (2010) Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda. PLoS One 5:e14098