Imperial College London
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DrFelicityFitzgerald

Faculty of Medicine, Department of Infectious Disease

Senior Clinical Research Fellow
 
 
 
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f.fitzgerald

 
 
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Norfolk PlaceSt Mary's Campus

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Publications

Citation

BibTex format

@article{Siika:2018:cid/cix1142,
author = {Siika, A and McCabe, L and Bwakura-Dangarembizi, M and Kityo, C and Mallewa, J and Berkley, J and Maitland, K and Griffiths, A and Baleeta, K and Mudzingwa, S and Abach, J and Nathoo, K and Thomason, MJ and Prendergast, AJ and Walker, AS and Gibb, DM and Mugyenyi, P and Kityo, C and Musiime, V and Wavamunno, P and Nambi, E and Ocitti, P and Ndigendawani, M and Kemigisa, M and Acen, J and Olebo, D and Mpamize, G and Amone, A and Okweny, D and Mbonye, A and Nambaziira, F and Rweyora, A and Kangah, M and Kabaswahili, V and Abach, J and Abongomera, G and Omongin, J and Aciro, I and Philliam, A and Arach, B and Ocung, E and Amone, G and Miles, P and Adong, C and Tumsuiime, C and Kidega, P and Otto, B and Apio, F and Baleeta, K and Mukuye, A and Abwola, M and Ssennono, F and Baliruno, D and Tuhirwe, S and Namisi, R and Kigongo, F and Kikyonkyo, D and Mushahara, F and Okweny, D and Tusiime, J and Musiime, A and Nankya, A and Atwongyeire, D and Sirikye, S and Mula, S and Noowe, N and Lugemwa, },
doi = {cid/cix1142},
journal = {Clinical Infectious Diseases},
pages = {S140--S146},
title = {Late presentation with HIV in Africa: phenotypes, risk, and risk stratification in the REALITY trial},
url = {http://dx.doi.org/10.1093/cid/cix1142},
volume = {66},
year = {2018}
}
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TY  - JOUR
AB  - © 2018 World Health Organization. Background. Severely immunocompromised human immunodefciency virus (HIV)-infected individuals have high mortality shortly afer starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods. Te Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children =5 years of age with CD4 counts  < 100 cells/μL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identifed using Cox regression with backwards elimination (exit P  > .1). Results. Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P  < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P =.02). Of fve late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/μL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/μL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/μL), but low symptom burden and maintained fat mass. Te remaining groups had 4%-6% mortality. Conclusions. Clinical and laboratory features identifed groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up.
AU  - Siika,A
AU  - McCabe,L
AU  - Bwakura-Dangarembizi,M
AU  - Kityo,C
AU  - Mallewa,J
AU  - Berkley,J
AU  - Maitland,K
AU  - Griffiths,A
AU  - Baleeta,K
AU  - Mudzingwa,S
AU  - Abach,J
AU  - Nathoo,K
AU  - Thomason,MJ
AU  - Prendergast,AJ
AU  - Walker,AS
AU  - Gibb,DM
AU  - Mugyenyi,P
AU  - Kityo,C
AU  - Musiime,V
AU  - Wavamunno,P
AU  - Nambi,E
AU  - Ocitti,P
AU  - Ndigendawani,M
AU  - Kemigisa,M
AU  - Acen,J
AU  - Olebo,D
AU  - Mpamize,G
AU  - Amone,A
AU  - Okweny,D
AU  - Mbonye,A
AU  - Nambaziira,F
AU  - Rweyora,A
AU  - Kangah,M
AU  - Kabaswahili,V
AU  - Abach,J
AU  - Abongomera,G
AU  - Omongin,J
AU  - Aciro,I
AU  - Philliam,A
AU  - Arach,B
AU  - Ocung,E
AU  - Amone,G
AU  - Miles,P
AU  - Adong,C
AU  - Tumsuiime,C
AU  - Kidega,P
AU  - Otto,B
AU  - Apio,F
AU  - Baleeta,K
AU  - Mukuye,A
AU  - Abwola,M
AU  - Ssennono,F
AU  - Baliruno,D
AU  - Tuhirwe,S
AU  - Namisi,R
AU  - Kigongo,F
AU  - Kikyonkyo,D
AU  - Mushahara,F
AU  - Okweny,D
AU  - Tusiime,J
AU  - Musiime,A
AU  - Nankya,A
AU  - Atwongyeire,D
AU  - Sirikye,S
AU  - Mula,S
AU  - Noowe,N
AU  - Lugemwa,A
AU  - Kasozi,M
AU  - Mwebe,S
AU  - Atwine,L
AU  - Senkindu,T
AU  - Natuhurira,T
AU  - Katemba,C
AU  - Ninsiima,E
AU  - Acaku,M
AU  - Kyomuhangi,J
AU  - Ankunda,R
AU  - Tukwasibwe,D
AU  - Ayesiga,L
AU  - Hakim,J
AU  - Nathoo,K
AU  - Bwakura-Dangarembizi,M
AU  - Reid,A
AU  - Chidziva,E
AU  - Mhute,T
AU  - Tinago,GC
AU  - Bhiri,J
AU  - Mudzingwa,S
AU  - Phiri,M
AU  - Steamer,J
AU  - Nhema,R
AU  - Warambwa,C
AU  - Musoro,G
AU  - Mutsai,S
AU  - Nemasango,B
AU  - Moyo,C
AU  - Chitongo,S
AU  - Rashirai,K
AU  - Vhembo,S
AU  - Mlambo,B
DO  - cid/cix1142
EP  - 146
PY  - 2018///
SN  - 1058-4838
SP  - 140
TI  - Late presentation with HIV in Africa: phenotypes, risk, and risk stratification in the REALITY trial
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/cix1142
UR  - http://hdl.handle.net/10044/1/60057
VL  - 66
ER  -
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