Background: There have been few reports of long-term survival of HIV-infected patients on antiretroviral therapy\r\n(ART) in Africa managed under near normal health service conditions.\r\nMethods: Participants starting ART between February 2005 and December 2006 in The AIDS Support (TASO) clinic\r\nin Jinja, Uganda, were enrolled into a cluster-randomised trial of home versus facility-based care and followed up\r\nto January 2009. The trial was integrated into normal service delivery with patients managed by TASO staff\r\naccording to national guidelines. Rates of survival, virological failure, hospital admissions and CD4 count over time\r\nwere similar between the two arms. Data for the present analysis were analysed using Cox regression analyses.\r\nResults: 1453 subjects were enrolled with baseline median count of 108 cells/�µl. Over time, 119 (8%) withdrew\r\nand 34 (2%) were lost to follow-up. 197/1453 (14%) died. Mortality rates (95% CI) per 100 person-years were 11.8\r\n(10.1, 13.8) deaths in the first year and 2.4 (1.8, 3.2) deaths thereafter. The one, two and three year survival\r\nprobabilities (95% CI) were 0.89 (0.87 - 0.91), 0.86 (0.84 - 0.88) and 0.85 (0.83 - 0.87) respectively. Low baseline CD4\r\ncount, low body weight, advanced clinical condition (WHO stages III and IV), not being on cotrimoxazole\r\nprophylaxis and male gender were associated independently with increased mortality. Tuberculosis, cryptococcal\r\nmeningitis and diarrhoeal disease were estimated to be major causes of death.\r\nConclusion: Practical and affordable interventions are needed to enable earlier initiation of ART and to reduce\r\nmortality risk among those who present late for treatment with advanced disease.
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