{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T08:50:41Z","timestamp":1791103841501,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,2,2]],"date-time":"2012-02-02T00:00:00Z","timestamp":1328140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2012,7]]},"abstract":"Objectives<\/jats:title>High early mortality after antiretroviral therapy (ART<\/jats:styled-content>) initiation in resource\u2010limited settings is associated with low baseline CD<\/jats:styled-content>4 cell counts and a high burden of opportunistic infections. Our large urban HIV<\/jats:styled-content> clinic in U<\/jats:styled-content>ganda has made concerted efforts to initiate ART<\/jats:styled-content> at higher CD<\/jats:styled-content>4 cell counts and to improve diagnosis and care of patients coinfected with tuberculosis (TB<\/jats:styled-content>). We sought to determine associated treatment outcomes.<\/jats:p><\/jats:sec>Methods<\/jats:title>Routinely collected data for all patients who initiated ART<\/jats:styled-content> from 2005 to 2009 were analysed. Median baseline CD<\/jats:styled-content>4 cell counts by year of ART<\/jats:styled-content> initiation were compared using the C<\/jats:styled-content>uzick test for trend. Mortality and TB<\/jats:styled-content> incidence rates in the first year of ART<\/jats:styled-content> were computed. Hazard ratios (HRs<\/jats:styled-content>) were calculated using multivariable C<\/jats:styled-content>ox proportional hazards models.<\/jats:p><\/jats:sec>Results<\/jats:title>First\u2010line ART<\/jats:styled-content> was initiated in 7659 patients; 64% were women, and the mean age was 37 years (standard deviation 9 years). Median baseline CD<\/jats:styled-content>4 counts increased from 2005 to 2009 [82\u2009cells\/\u03bcL<\/jats:styled-content> (interquartile range (IQR<\/jats:styled-content>) 24, 153) to 148\u2009cells\/\u03bcL<\/jats:styled-content> (IQR<\/jats:styled-content> 61, 197), respectively; P<\/jats:styled-content>\u2009<\/jats:italic><\u20090.001]. The mortality rate fell from 6.5\/100 person\u2010years at risk (PYAR<\/jats:styled-content>) [95% confidence interval (CI<\/jats:styled-content>) 5.5\u20137.6 PYAR<\/jats:styled-content>] to 3.6\/100 PYAR<\/jats:styled-content> (95% CI<\/jats:styled-content> 2.2\u20135.8 PYAR<\/jats:styled-content>). TB<\/jats:styled-content> incidence rates increased from 8.2\/100 PYAR<\/jats:styled-content> (95% CI<\/jats:styled-content> 7.1\u20139.5 PYAR<\/jats:styled-content>) to 15.6\/100 PYAR<\/jats:styled-content> (95% CI<\/jats:styled-content> 12.4\u201319.7 PYAR<\/jats:styled-content>). A later year of ART<\/jats:styled-content> initiation was independently associated with decreased mortality (HR<\/jats:styled-content> 0.91; 95% CI<\/jats:styled-content> 0.83\u20131.00; P<\/jats:styled-content>\u2009<\/jats:italic>=\u20090.04).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Baseline CD<\/jats:styled-content>4 cell counts have increased over time and are associated with decreased mortality. Additional reductions in mortality might be a result of a better standard of care and increased TB<\/jats:styled-content> case finding. Further efforts to initiate ART<\/jats:styled-content> earlier should be prioritized even in a setting of capped or reduced funding for ART<\/jats:styled-content> programmes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1468-1293.2011.00980.x","type":"journal-article","created":{"date-parts":[[2012,2,2]],"date-time":"2012-02-02T05:16:24Z","timestamp":1328159784000},"page":"337-344","source":"Crossref","is-referenced-by-count":19,"title":["Earlier initiation of antiretroviral therapy, increased tuberculosis case finding and reduced mortality in a setting of improved HIV<\/scp> care: a retrospective cohort study"],"prefix":"10.1111","volume":"13","author":[{"given":"SM","family":"Hermans","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute Makerere University College of Health Sciences Kampala Uganda"},{"name":"Department of Global Health Academic Medical Center University of Amsterdam, Amsterdam Institute for Global Health and Development Amsterdam the Netherlands"},{"name":"Department of Internal Medicine and Infectious Diseases University Medical Center Utrecht Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"van Leth","sequence":"additional","affiliation":[{"name":"Department of Global Health Academic Medical Center University of Amsterdam, Amsterdam Institute for Global Health and Development Amsterdam the Netherlands"},{"name":"KNCV Tuberculosis Foundation The Hague the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YC","family":"Manabe","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute Makerere University College of Health Sciences Kampala Uganda"},{"name":"Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AIM","family":"Hoepelman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases University Medical Center Utrecht Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JMA","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Global Health Academic Medical Center University of Amsterdam, Amsterdam Institute for Global Health and Development Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Kambugu","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute Makerere University College of Health Sciences Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,2,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09411-4"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67022-5"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60612-7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000189858.59559.d2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0807252"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0910370"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/586713"},{"key":"e_1_2_7_9_1","unstructured":"Department of Health and Human Services.Panel on Antiretroviral Guidelines for Adults and Adolescents. 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