Early Mortality in HIV Infected Patients Starting Antiretroviral Therapy in Afric

描述（由申请人提供）： 抗逆转录病毒疗法终于惠及非洲数百万艾滋病毒感染者。虽然挽救了无数生命，但越来越明显的是，与工业化环境相比，抗逆转录病毒疗法前6个月的死亡人数急剧上升，可能是工业化环境的五倍。然而，即使是这些令人震惊的估计数也可能被低估，因为在资源有限的情况下，需要跟进的大量损失意味着许多死亡无法确定。此外，这些过早死亡的原因也没有得到很好的解释。因此，提出的目标寻求（1）评估我们开发的基于抽样的技术，以了解早期死亡率的真实程度;（2）通过收集生物标本并在旧金山弗朗西斯科进行深入调查，确定未确诊的机会性感染是否是ART早期死亡的原因;（3）制定临床预测规则，对个体患者在ART开始时的早期死亡率进行风险分层。总的来说，这项研究旨在了解非洲艾滋病毒感染者接受抗逆转录病毒治疗后早期死亡率的大小和决定因素，以便在未来制定有针对性的干预措施来减少死亡率。这些目标也将为完成进一步的职业发展提供平台，以实现作为科学家的独立性。 相关性：在非洲数百万开始抗逆转录病毒治疗的患者中，抗逆转录病毒治疗的早期死亡率可能为十分之一。这些死亡可能是由于可治疗的感染。因此，更好地了解非洲抗逆转录病毒疗法的早期死亡率有可能改善抗逆转录病毒疗法的提供并挽救许多生命。

DESCRIPTION (provided by applicant): Antiretroviral therapy is finally reaching millions of persons with HIV infection in Africa. While countless lives have been saved, it is becoming increasingly clear that deaths in the first 6 months on ART are dramatically elevated as compared to industrialized settings, - perhaps claiming as many as five-fold more than in industrialized settings. Even these alarming estimates, however, are likely underestimates because high losses to follow up in resource limited settings mean that many deaths are not ascertained. The causes of these early deaths, furthermore, are not well explained. Therefore the proposed Aims seek to (1) evaluate a sampling-based technique that we have developed to understand the true magnitude of early mortality; (2) determine whether undiagnosed opportunistic infections are the cause of early mortality on ART by collecting biological specimens and investigating them intensively in San Francisco and (3) develop a clinical prediction rule to risk stratify individual patients for early mortality at the time or ART initiation. Overall, this study seeks to understand the magnitude and determinants of early mortality on ART in HIV infected patients in Africa in order to develop a targeted intervention in the future to reduce it. These Aims will also provide a platform for completing further career development toward independence as a scientist. RELEVANCE: Early mortality on ART may claim 1 in 10 patients of the millions of patients starting ART in Africa. These deaths are likely due to treatable infections. Therefore, a better understanding of early mortality on ART in Africa has the potential to improve ART delivery and save many lives.