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Inability to trace patients with HIV disease receiving HAART may lead to global overestimation of survival rates

The purpose of global scale-up efforts to provide highly active antiretroviral therapy (HAART) to patients with HIV disease in resource-strapped countries, such as those in sub-Saharan Africa, is to improve survival. However, many patients in these countries are lost to followup. A new study found that nearly 60 percent of these "lost" patients died shortly after receiving HAART. This suggests that the effectiveness of global HAART scale-up efforts in resource-limited countries may be overestimated. Researchers at the University of Pennsylvania Center for Education and Research on Therapeutics and African colleagues analyzed data from a large public HAART program in sub-Saharan Africa, Botswana's National Antiretroviral Therapy Program.

They compared reports of clinical outcomes and risk factors for death among 410 patients with HIV disease within a year after HAART initiation both before and after tracing patients lost to followup. Of 68 patients initially categorized as lost, 59 percent were confirmed dead after tracing. Patient tracing revealed significantly lower survival rates than before tracing (0.92 before tracing and 0.83 after tracing). Moreover, a nearly twofold increased risk of death after HAART among men would have been missed had patients not been traced. Thus, important risk factors for death may be missed if patients are not actively traced, note the researchers. Interventions designed to decrease death after HAART initiation will need to include methods to identify, locate, diagnose, and, if possible, treat incident illnesses among those who miss even a single clinic visit, suggest the authors.

Their study was supported in part by a grant from the Agency for Healthcare Research and Quality (HS10399) to the University of Pennsylvania Center for Education and Research on Therapeutics (CERT). For more information on the CERT program, please visit http://www.ahrq.gov

See "Overestimates of survival after HAART: Implications for global scale-up efforts," by Gregory P. Bisson, M.D., M.S.C.E., Tendani Gaolathe, M.D., Robert Gross, M.D., M.S.C.E., and others in the March 5, 2008 PLoS ONE 3(3), pp. e1725-e1730.

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