Table 2.
All-cause mortality among adults on ART by sex
| Crude n (%) | Rate/100 py | cHR (95% CI), females | aHR (95% CI), females | ||||||
|---|---|---|---|---|---|---|---|---|---|
| First author, date, country [Ref.] | Males | Females | Males | Females | Males | Females | Males | Females | Timeb |
| Africa | |||||||||
| Abaasa, 2008, Uganda [20] | 34 (15.3) | 130 (19.3) | 10.2 | 12.6 | 1.26 (0.86–1.83) | Ref | 1.48 (0.98–2.17) | Ref | 31.2 |
| Ahonkhai, 2012, South Africa [21] | 372 (9.7) | 616 (8.1) | – | – | Ref | OR 0.86 (0.75–0.99) | – | – | 6.9 |
| Alamo, 2012, Uganda [22] | 29 (12.2) | 37 (10.8) | – | – | – | – | – | – | 10 |
| Alemu, 2010, Ethiopia [23] | – | – | – | – | 1.22 (0.58–2.56) | Ref | – | – | 24 |
| Alibhai, 2010, Uganda [24] | 22 (13.5) | 20 (9.0) | – | – | – | – | – | – | 5.6 |
| Balcha, 2010, Ethiopia [25] | 78 (11.1) | 97 (9.6) | – | – | – | – | – | – | 24 |
| Bastard, 2011, Senegal [26] | – | – | – | – | – | – | Ref | 0.47 (0.26–0.84) | 108 |
| Biadgilign, 2012, Ethiopia [27] | – | – | – | – | Ref | 1.05 (0.68–1.64) | Ref | 1.16 (0.68–2.00) | 60 |
| Birbeck, 2011, Zambia [28] | 36 (17.6) | 65 (22.5) | – | – | OR 0.72 (0.47–1.15) | Ref | – | – | 24 |
| Bisson, 2008, Botswana [29] | 36 (21.7), p =0.03 | 33 (15.0) | – | – | – | – | 1.74 (1.05–2.87)c | Ref | 12 |
| Boyles, 2011, South Africa [30] | – | – | – | – | – | – | Ref | 1.20 (0.87–1.66) | 48 |
| Brennan, 2013, South Africa [31] | 906 (9.9) | 1079 (18.7) | – | – | RR 1.40 (1.30–1.60) | Ref | RR 1.0 (0.90–1.10) | Ref | 84 |
| Brinkhof, 2009, 4 countries [32] | – | – | 10.24 (9.66)d | 6.98 (6.69)d | – | – | Ref | 0.84 (0.71–0.99) | 24 |
| Chalamilla, 2012, Tanzania [33] | – | – | – | – | – | – |
1.19 (1.06–1.34),
p
<0.001
1.19 (1.07–1.32), p <0.001 |
Ref Ref |
<3 36 |
| Chen, 2008, Malawi [34] | 188 (16.8), p <0.0001 | 188 (11.0) | – | – | – | – | 1.70 (1.35–2.15) | Ref | 30 |
| Chi, 2009, Zambia [35] | – | – | – | – | 1.40 (1.20–1.60) | Ref | 1.30 (1.10–1.50) | Ref | 12–36 |
| Chi, 2010, Zambia [36] | – | – | – | – | – | – | 1.82 (1.47–2.26) | Ref | 30 |
| Chu, 2010, Malawi [37] | 175 (0.13), KS | 77 (22.3), KS | – | – | 0.98 (0.73–1.31), KS | Ref | – | – | 13 |
| Cornell, 2009, South Africa [38] | 51 (7.0) 14 (3.0) |
59 (4.0) 32 (3.0) |
22.8,
p
=0.002
3.5 |
12.5
3.8 |
1.83 (1.26–2.26),
p
=0.02
0.98 (0.52–1.84) |
Ref Ref |
1.46 (0.96–2.22) 0.70 (0.37–1.34) |
Ref Ref |
0–4 4–12 |
| Cornell, 2012, South Africa [39] | – | – | – | – |
1.28 (1.09–1.51) 1.63 (1.37–1.94) 1.62 (1.22–2.14) 1.71 (1.08–2.70) 1.46 (1.37–1.56) |
Ref Ref Ref Ref Ref |
1.10 (0.93–1.31) 1.36 (1.05–1.78) 1.39 (0.94–2.06) 1.35 (0.76–2.38) 1.31 (1.22–1.41) |
Ref Ref Ref Ref Ref |
0–12 12–24 24–36 36–84 0–84 |
| Dalal, 2008, South Africa [40] | 31 (5.6)c | 52 (4.8)c | – | – | – | – | – | – | 15 |
| De Beaudrap, 2008, Senegal [41] | – | – | – | – | Ref | 1.03 (0.50–2.15) 0.69 (0.42–1.16) |
– | – | 0–6 6–84 |
| De Luca, 2012, 3 countries [42] | – | – | – | – | Ref | 0.60 (0.40–0.90), p =0.015 | Ref | 0.57 (0.36–0.90), p =0.017 | 6–48 |
| Deribe, 2013, Ethiopia [43] | 40 (32.3), TB | 28 (18.8), TB | – | – | OR 2.06 (1.18–3.59), TB | Ref | OR 2.04 (1.04–4.02), p =0.039, TB | Ref | 48 |
| Desilva, 2009, Nigeria [44] | – | – | – | – | – | – | 1.76 (1.14–2.72), p =0.0114 | Ref | 24 |
| Ekouevi, 2010, 5 countries [45] | 1.14 (1.08–1.21), p =0.0004e | Ref | 1.16 (1.10–1.24), p =0.0002e | Ref | 12 | ||||
| Evans, 2012, South Africa [46] | – | – | – | – | 1.17 (0.99–1.37) | Ref | – | – | 12 |
| Fatti, 2010, South Africa [47] | – | – | – | – | – | – | 1.14 (1.00–1.30), p =0.047 | Ref | 36 |
| Ford, 2010, Lesotho [48] | – | – | – | – | – | – | 0.90 (0.34–2.38) | Ref | 24 |
| Fox, 2010, South Africa [49] | 278 (12.5) | 398 (10.0) | – | – | 1.25 (1.08–1.44) | Ref | – | – | 48 |
| Fox, 2012, South Africa [50] | – | – | 3.34 | 3.46 | Ref | 1.02 (0.91–1.14) | Ref | 0.95 (0.81–1.12); 0.86 (0.76–0.97)d | 6–96 |
| Franke, 2011, Rwanda [16] | – | – | – | – | – | – | Ref | 1.6 (0.8–3.2), TB | 24 |
| Geng, 2010a, Uganda [51] | 46 (41.0)f | 65 (59.0)f | – | – | 0.85 (0.42–1.75)f | Ref | 1.54 (0.53–4.12)f | Ref | 45 |
| Geng, 2010b, Uganda [52] | – | – | – | – |
2.19 (1.30–3.72),
p
<0.01
1.11 (0.65–1.92)c |
Ref Ref |
1.86 (1.06–3.26),
p
=0.03
1.02 (0.57–1.83)c |
Ref Ref |
45 |
| Greig, 2012, 9 countries [53] | – | – | – | – |
1.33 (1.14–1.54),
p
<0.001
1.34 (1.13–1.59), p =0.001 |
Ref Ref |
1.20 (1.01–1.41),
p
=0.035
1.02 (0.84–1.22) |
Ref Ref |
0–3 3–24 |
| Hawkins, 2011, Tanzania [54] | 643 (14.6) | 1039 (12.3) | – | – | 1.23 (1.12–1.36), p <0.01 | Ref | 1.19 (1.05–1.30), p =0.001 | Ref | 33 |
| Hermans, 2012, Uganda [55] | – | – | – | – | 1.82 (1.47–2.25), p <0.001 | Ref | 1.41 (1.12–1.77), p =0.004 | Ref | 12 |
| Hoffmann, 2010, South Africa [56] | 1044 (12.0) | 432 (8.0) | – | – | Ref | 0.75 (0.66–0.86), p <0.001 | Ref | 0.89 (0.77–1.0) | 12 |
| Hoffmann, 2011, South Africa [57] | 1706 (17.8) | 952 (17.5) | 9.85 | 9.03 |
1.30 (1.20–1.50)
1.20 (0.99–1.40) 1.30 (1.20–1.40), p <0.001 |
Ref Ref Ref |
– – 1.20 (1.00–1.30), p =0.004 |
– – Ref |
0–12 13–48 >48 |
| Johannessen, 2008, Tanzania [58] | 38 (39.2) | 57 (25.6) | – | – | 1.73 (1.15–2.61), p =0.009 | Ref | 1.60 (1.00–2.57), p=0.053 | Ref | 36 |
| Karstaedt, 2012, South Africa [59] | 118 (11.5) | 187 (11.6) | – | – | – | – | – | – | 60 |
| Kassa, 2012, Ethiopia [60] | – | – | – | 1.19 (0.95–1.50) | Ref | 1.07 (0.84–1.36) | Ref | 60 | |
| Kebebew, 2012, Ethiopia [61] | 64 (11.7) | 22 (11.8) | – | – | – | – | – | – | 48 |
| Kipp, 2012, Uganda [62] | 56 (31.8)e | 58 (26.1)e | – | – | – | – | – | – | 24 |
| Kouanda, 2012, Burkina Faso [63] | – | – | – | – | 1.73 (1.49–2.02), p <0.001 | Ref | 1.33 (1.05–1.68), p =0.02 | Ref | 70 |
| Lowrance, 2009, Rwanda [64] | – | – | – | – | Ref Ref |
OR 0.67
(0.46–0.98) OR 0.88 (0.62–1.26) |
Ref Ref |
OR 0.56
(0.37–0.84) 0.83 (0.56–1.12) |
6 12 |
| MacPherson, 2009, South Africa [65] | – | – | – | – | 1.55 (1.09–2.21) | Ref | 1.63 (1.12–2.36) | Ref | 24 |
| Mageda, 2012, Tanzania [66] | 31 (13.7) | 16 (5.0) |
7.83
(5.51–11.14), p =0.001 |
2.30
(1.41–3.76) |
3.19 (1.74–5.84) | Ref | 4.71 (2.00–11.05), p =0.001 | Ref | 12–60 |
| Maman, 2012a, 3 countries [67] | 84 (2) | 119 (1) | – | – | – | – | – | – | 72 |
| Maman, 2012b, 3 countries [68] | 246 | 322 | 1.15 | 0.67 | – | – | 1.33 (1.10–1.61) | Ref | 9–60 |
| Maman, 2012c, Malawi [69] | 60 (25.5) | 58 (17.2) | 85.3 (60/70.3 py) | 55.6 (58/104.3 py) | 1.53 (1.07–2.19), p =0.021 | Ref | 1.36 (0.93–2.00) | Ref | 12 |
| Maskew, 2012, South Africa [70] | 364 (10.4) 446 (12.8) |
446 (7.9) 546 (9.7) |
– | – |
1.35 (1.17–1.55)
1.36 (1.20–1.54) |
Ref Ref |
1.23 (1.06–1.42)
1.23 (1.08–1.41) |
Ref Ref |
0–12 12–24 |
| Maskew, 2013, South Africa [71] | 143 (5.2) | 190 (4.1) | – | – | 1.00 (0.70–1.50) 1.20 (0.9–1.60) 1.30 (1.0–1.60) |
Ref Ref Ref |
1.00 (0.70–1.50) 1.20 (0.90–1.60) 1.20 (0.90–1.60) |
Ref Ref Ref |
0–12 12–24 24–36 |
| Massaquoi, 2009, Malawi [72] | 63 (4.3) | 85 (3.2) | – | – | – | – | – | – | 14 |
| Moore, 2011, Uganda [73] | 38 (10.8), p=0.093 | 74 (9.0) | – | – | – | – | – | – | 60 |
| Mossdorf, 2011, Tanzania [74] | 130 (25.1)e | 188 (19.9)e | – | – | Ref | 0.77 (0.62–0.97) e | Ref | 0.77 (0.52–1.15)e | 12 |
| Mosha, 2013, Tanzania [75] | 14 (20.0) | 21 (12.8) | – | – | – | – | – | – | 12 |
| Mujugira, 2009, Botswana [17] | – | – | – | – | Ref | 0.83 (0.52–1.33) (CD4 <50) |
Ref | 0.68 (0.33–1.38) (CD4 <50) |
12 |
| Murphy, 2010, South Africa [76] | 4 (6.0) | 4 (6.0) | – | – | – | – | OR 1.50 (0.20–12.30) | Ref | 5.3 |
| Mutevedzi, 2010, South Africa [77] | – | – | – | – | 1.62 (1.49–1.77) | Ref | 1.33 (1.06–1.67) | Ref | 12 |
| Mutevedzi, 2011, South Africa [78] | – | – | – | – | – | – | <50 yo, 1.64 (1.32–2.03) | Ref | 0–3 |
| ≥50 yo, 1.84 (1.06–3.17) | Ref | 0–3 | |||||||
| <50 yo, 1.40 (1.09–1.80) | Ref | 3–12 | |||||||
| >50 yo, 1.33 (0.73–2.41) | Ref | 3–12 | |||||||
| 1.95 (1.46–2.57) | Ref | 12–24 | |||||||
| Mzileni, 2008, South Africa [79] | 193 (28.0), p <0.0001 | 119 (8.0) | – | – | – | – | – | – | 18 |
| Negin, 2011, Malawi [80] | – | – | – | – | – | – | Ref | 0.52 (0.46–0.60), p <0.0001 | 60 |
| Nglazi, 2011, South Africa [81] | – | – | – | – | – | – | 1.48 (1.17–1.88), p =0.001 | Ref | 84 |
| Odafe, 2012, Nigeria [82] | – | – | – | – | 1.70 (1.22–2.39), p =0.002 | Ref | 1.29 (0.89–1.86) | Ref | 36 |
| Ojikutu, 2008, South Africa [83] | 26 (20.0) | 23 (13.0) | – | – | Ref | 0.69 (0.38–1.25) | Ref | 0.75 (0.40–1.38) | 62 |
| Palombi, 2009, 3 countries [84] | – | – | – | – | Ref | 0.58 (0.48–0.71), p <0.001 | Ref |
Model 1:
0.51 (0.40–0.63),
p
<0.001
Model 2: 0.45 (0.34–0.59), p <0.001 |
42 |
| Palombi, 2010, Mozambique [85] | – | – | – | – | 1.49 (0.96–2.31) | Ref | 1.81 (1.08–3.02) | Ref | 3 |
| Peltzer, 2011, South Africa [86] | – | – | – | – | RR 1.21 (0.70–2.09) | Ref | – | – | 12 |
| Peterson, 2011, Gambia [87] | – | – | – | – |
2.00 (1.00–3.90),
p
=0.0365
2.20 (0.90–5.80) |
Ref Ref |
4.90 (2.50–10.80),
p
<0.0001
2.50 (1.20–5.60), p =0.0184 |
Ref Ref |
0–6 6–36 |
| Poka–Mayap, 2013, Cameroon [88] | – | – | – | – | 1.44 (0.94–2.11) | Ref | 2.15 (1.34–3.45), p =0.002 | Ref | 60 |
| Rougemont, 2009, Cameroon [89] | – | – | – | – | Ref | OR 0.68 (0.30–1.55) | – | – | 6 |
| Russell, 2010, South Africa [90] | – | – | – | – | Ref | 0.89 (0.65–1.23) | Ref | 0.87 (0.63–1.20) | 9 |
| Schoni–Affolter, 2011, Zambia [91] | 3986 (11.5) | 4512 (8.3) | – | – | – | – | – | – | 41 |
| Sieleunou, 2009, Cameroon [92] | – | – | – | – | – | – | 1.73 (1.37–2.19), p <0.001 | Ref | 60 |
| Siika, 2010, Kenya [93] | 241 (39.3) | 286 (29.5) | – | – | – | – | Ref | 0.71 (0.55–0.99) | 5.75 |
| Somi, 2010, Tanzania [94] | 3580 (12.0) | 4746 (8.0) | – | – | Ref | Min. estimate: 0.65 (0.62–0.68); Max. estimate: 0.95 (0.93–0.97) | Ref | Min. estimate 0.59 (0.56–0.62); Max. estimate: 0.88 (0.86–0.91) | 60 |
| Steele, 2011, Botswana [95] | 19 (12.5) | 18 (7.2) | – | – | RR 1.74 (0.94–3.20) | Ref | – | – | 6 |
| Sunpath, 2012, South Africa [96] | 49 (25.0) | 49 (26.0) | – | – | 0.90 (0.60–1.50) | Ref | – | – | 5.5 |
| Taylor–Smith, 2010, Malawi [97] | 341 (14.5) | 206 (8.8) | 15.71 (14.13–17.47) | 9.80 (7.93–10.41) | RR 1.73 (1.45–2.06) | Ref | RR 1.90 (1.57–2.29) | Ref | 36 |
| Toure, 2008, Côte d’Ivoire [98] | – | – | – | – | – | – | 1.52 (1.29–1.80), p <0.0001 | Ref | 32 |
| Van Cutsem, 2011, South Africa [99] | – | – | – | – | 1.69 (1.16–2.47), p =0.007 e | Ref | 1.14 (0.74–1.76)e | Ref | 24 |
| Wandeler, 2012, 3 countries [100] | – | – | – | – | Ref | Sub-HR 0.69 (0.59–0.80), p <0.001 | – | – | 36 |
| Weigel, 2011, Malawi [101] | – | – | – | – | – | – | 1.0 (Ref) | OR 0.85 (0.56–1.29), p=0.45 | na |
| Wubshet, 2012, Ethiopia [102] | – | – | – | – | – | – | 3.26 (2.19–4.88), p <0.001 | Ref | 66 |
| Zachariah, 2009, Malawi [103] | 84 (12.1), p=0.001 | 122 (7.7) | – | – | OR 1.60 (1.20–2.20) | Ref | OR 1.60 (1.20–2.10), p =0.03 | Ref | 3 |
| Eastern Europe/central Asia | |||||||||
| Tsertsvadze, 2011, Georgia [14] | – | – | – | – | 2.14 (1.38–2.32) | Ref | 1.96 (1.19–3.24) | Ref | 60 |
| Latin America/Caribbean | |||||||||
| Wolff, 2010, Chile [104] | – | – | – | – | 1.23 (0.95–1.62) | Ref | 0.81 (0.61–1.08) | Ref | 84 |
| Asia | |||||||||
| Alvarez-Uria, 2013, India [105] | – | – | – | – | – | – | Ref | 0.65 (0.52–0.83) | 60 |
| Argemi, 2012, Cambodia [106] | – | – | – | – | Ref | 0.78 (0.53–1.14) | – | – | 56 |
| Bastard, 2013, Laos [107] | – | – | – | – | – | – | Ref Ref |
1.19 (0.69–2.05) 0.17 (0.07–0.44), p <0.001 |
0–9 10–60 |
| Bhowmik, 2012, India [108] | 43 (8.6) | 13 (5.4) | – | – | – | – | – | – | 12 |
| Chen, 2013, China [109] | 88 (7.3) | – | – | 2.70 (1.70–4.40) | Ref | 2.10 (1.20–3.50) | Ref | 14 | |
| Dou, 2011, China [110] | 292 (14.3) | 151 (10.7) | – | – |
1.38 (1.13–1.68)
1.12 (0.86–1.45) 1.56 (1.15–2.11) |
Ref Ref Ref |
– 1.31 (0.95–1.81) 1.46 (1.04–2.06) |
– Ref Ref |
24 <3 3–24 |
| Fregonese, 2012, Thailand [111] | 14 20 |
23 32 |
7.2 (4.2–12.1) 1.5 (1.0–2.3) |
4.2 (2.8–6.3) 0.80 (0.6–1.2) |
1.70 (0.90–3.40) 1.80 (1.00–3.01) |
Ref Ref |
1.50 (0.70–3.10) 2.40 (1.20–4.80), p =0.01 |
Ref Ref |
3–6 7–60 |
| Kumarasamy, 2008, India [112] | 6.2%, p =0.033 | 4.0% | – | – | – | – | – | – | 12 |
| Limmahakhun, 2012, Thailand [113] | 4 (4.0), TB | 2 (2.8), TB | – | – | – | – | – | – | 120 |
| Rai, 2013, India [114] | 86 (47.3) | 18 (31.6) | 34.4 (27.9–42.5) | 16.6 (10.4–26.3) | – | – | 2.80 (1.60–4.90) | Ref | 36 |
| Sabapathy, 2012, Burma [115] | – | – | 19.6 (17.6–21.8) 4.9 (4.4–5.5) |
14.9 (12.8–17.3) 4.3 (3.7–4.9) |
1.31 (1.09–1.59)
1.16 (0.87–1.38), p=0.09e |
Ref Ref |
1.29 (0.94–1.78) 1.63 (1.23–2.15), p <0.001 e |
Ref Ref |
0–6 7–36 |
| Susaengrat, 2011, Thailand [116] | 75 (13.7) | 50 (11.4) | – | – | – | – | – | – | 45 |
| Thai, 2009, Cambodia [117] | – | – | – | – | 1.55 (1.18–2.05), p =0.002 e | Ref | 1.73 (1.29–2.32), p <0.001 e | Ref | 57 |
| Tran, 2013, Vietnam [118] | 141 (5.5) | 57 (6.6) | – | – | Ref | 0.40 (0.29–0.57) | Ref | 0.54 (0.34–0.85) | 0–6 |
| Van Griensven, 2011, Cambodia [119] | 60 (4.5) 38 |
37 (2.5) 26 |
10.45 1.27 |
5.44 0.77 |
Ref Ref |
0.52 (0.35–0.70),
p
<0.01
0.60 (0.36–0.99), p =0.04 |
Ref Ref |
0.48 (0.31–0.74),
p
<0.01
0.58 (0.34–0.99), p =0.05 |
0–6 6–60 |
| Zhang, 2008, China [120] | 208 (16) | 144 (10.3) | – | – | 1.60 (1.30–2.00), p <0.001 | Ref | 1.90 (1.20–2.90), p =0.004 | Ref | 144 |
| Zhang, 2009, China [121] | 4136, (14.6) p<0.001 | 2354 (11.5) | 9 | 5.7 | 1.50 (1.40–1.50) | Ref | 1.40 (1.03–1.50) | Ref | 60 |
| Zhang, 2012, China [122] | – | – | – | – | 1.50 (1.40–1.70) | Ref | 1.50 (1.20–1.70) | Ref | 6–48 |
| Multi-regional | |||||||||
| Brinkhof, 2008, 11 countries [123] | – | – | – | – | – | – | Ref | 0.83 (0.58–1.18) | 6 |
| Wandel, 2008, 3 countries [124] | – | – | – | – | Ref | Ranged 0.91–1.09, none significant | – | – | 330 |
Bold indicates significant outcomes; cHR, crude, unadjusted hazard ratio; aHR, adjusted hazard ratio; CI, confidence interval; OR, odds ratios; RR, relative risk ratio; Ref, referent; sub-HR, subdistribution hazard ratio; TB, tuberculosis co-infection; py, person-years; KS, patients with Kaposi’s sarcoma; yo, years old
a
Cox proportional hazard ratio, unless otherwise noted
b
Time in months since initiation of ART
c
Includes deaths among patients who were lost to follow-up and then traced (included in MA)
d
with multiple imputations
e
both known deaths and patients lost to follow-up (LTFU) in one measure (excluded from MA)
f
exclusively patients who were LTFU and traced.