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dc.contributor.authorWong, Emily Beth
dc.contributor.authorOmar, Tanvier
dc.contributor.authorSetlhako, Gosetsemang J.
dc.contributor.authorOsih, Regina
dc.contributor.authorFeldman, Charles
dc.contributor.authorMurdoch, David M.
dc.contributor.authorMartinson, Neil A.
dc.contributor.authorBangsberg, David Roy
dc.contributor.authorVenter, W. D. F.
dc.date.accessioned2013-04-08T19:07:19Z
dc.date.issued2012
dc.identifier.citationWong, Emily B., Tanvier Omar, Gosetsemang J. Setlhako, Regina Osih, Charles Feldman, David M. Murdoch, Neil A. Martinson, David R. Bangsberg, and W. D. F. Venter. 2012. Causes of death on antiretroviral therapy: a post-mortem study from South Africa. PLoS ONE 7(10): e47542.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10511335
dc.description.abstractBackground: Mortality in the first months of antiretroviral therapy (ART) is a significant clinical problem in sub-Saharan Africa. To date, no post-mortem study has investigated the causes of mortality in these patients. Methods: HIV-positive adults who died as in-patients at a Johannesburg academic hospital underwent chart-review and ultrasound-guided needle autopsy for histological and microbiological examination of lung, liver, spleen, kidney, bone marrow, lymph node, skin and cerebrospinal fluid. A clinico-pathologic committee considered all available data and adjudicated immediate and contributing causes of death. Results: Thirty-nine adults were enrolled: 14 pre-ART, 15 early-ART (7–90 days), and 10 late-ART (>90 days). Needle sampling yielded adequate specimen in 100% of kidney, skin, heart and cerebrospinal fluid samples, 97% of livers and lungs, 92% of bone marrows, 87% of spleens and 68% of lymph nodes. Mycobacterial infections were implicated in 69% of deaths (26 of 27 of these due to M. tuberculosis), bacterial infections in 33%, fungal infections in 21%, neoplasm in 26%, and non-infectious organ failure in 26%. Immune reconstitution inflammatory syndrome (IRIS) was implicated in 73% of early-ART deaths. Post-mortem investigations revealed previously undiagnosed causes of death in 49% of cases. Multiple pathologies were common with 62% of subjects with mycobacterial infection also having at least one other infectious or neoplastic cause of death. Conclusions: Needle biopsy was efficient and yielded excellent pathology. The large majority of deaths in all three groups were caused by M. tuberculosis suggesting an urgent need for improved diagnosis and expedited treatment prior to and throughout the course of antiretroviral therapy. Complex, unrecognized co-morbidities pose an additional challenge.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0047542en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472995/pdf/en_US
dash.licenseLAA
dc.subjectBiologyen_US
dc.subjectHistologyen_US
dc.subjectMedicineen_US
dc.subjectDiagnostic Medicineen_US
dc.subjectPathologyen_US
dc.subjectAnatomical Pathologyen_US
dc.subjectAutopsy Pathologyen_US
dc.subjectForensic Pathologyen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectFungal Diseasesen_US
dc.subjectCryptococcosisen_US
dc.subjectTropical Diseases (Non-Neglected)en_US
dc.subjectTuberculosisen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectHIV clinical manifestationsen_US
dc.subjectHIV opportunistic infectionsen_US
dc.titleCauses of Death on Antiretroviral Therapy: A Post-Mortem Study from South Africaen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorBangsberg, David Roy
dc.date.available2013-04-08T19:07:19Z
dc.identifier.doi10.1371/journal.pone.0047542*
dash.contributor.affiliatedBangsberg, David R.
dash.contributor.affiliatedWong, Emily


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