Converging Mortality Rates After ART Initiation for HIV-Infected Patients in South Africa and North America

Many studies have covered the mortality observed in HIV treatment cohorts from Europe and North America. Now, researchers have compared mortality after antiretroviral therapy (ART) initiation among four cohorts from South Africa (n=30,467), nine from Europe (n=29,727), and six from North America (n=7160).

Patients in South Africa began ART at much lower CD4 counts than those in Europe or North America (median, 102 cells/mm³ vs. 213 and 172, respectively). Early mortality was highest in the South African cohort (mostly in patients starting ART with CD4 counts <50 cells/mm³). At 4 years, cumulative mortality was 16.6%, 4.7%, and 15.3% in the three cohort groups. At 3 to 4 years, after adjustment for patient characteristics at ART initiation, m…