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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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Post:2018:cid/cix1141,
author = {Post, FA and Szubert, AJ and Prendergast, AJ and Johnston, V and Lyall, H and Fitzgerald, F and Musiime, V and Musoro, G and Chepkorir, P and Agutu, C and Mallewa, J and Rajapakse, C and Wilkes, H and Hakim, J and Mugyenyi, P and Walker, AS and Gibb, DM and Pett, SL},
doi = {cid/cix1141},
journal = {Clinical Infectious Diseases},
pages = {S132--S139},
title = {Causes and timing of mortality and morbidity smong late presenters dtarting antiretroviral therapy in the REALITY trial},
url = {http://dx.doi.org/10.1093/cid/cix1141},
volume = {66},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundIn sub-Saharan Africa, 20%–25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity.MethodsParticipants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non–mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azithromycin-responsive infections, other events, and unknown.ResultsMedian pre-ART CD4 count was 37 cells/µL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-responsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2).ConclusionsEnhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease.
AU  - Post,FA
AU  - Szubert,AJ
AU  - Prendergast,AJ
AU  - Johnston,V
AU  - Lyall,H
AU  - Fitzgerald,F
AU  - Musiime,V
AU  - Musoro,G
AU  - Chepkorir,P
AU  - Agutu,C
AU  - Mallewa,J
AU  - Rajapakse,C
AU  - Wilkes,H
AU  - Hakim,J
AU  - Mugyenyi,P
AU  - Walker,AS
AU  - Gibb,DM
AU  - Pett,SL
DO  - cid/cix1141
EP  - 139
PY  - 2018///
SN  - 1058-4838
SP  - 132
TI  - Causes and timing of mortality and morbidity smong late presenters dtarting antiretroviral therapy in the REALITY trial
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/cix1141
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000429443300006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/74085
VL  - 66
ER  -
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