Correspondence: D. D. Cuong, Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Solna Campus, Nobels väg 9, SE-171 77, Stockholm, Sweden. Tel: + 46 8 524 8336. Fax: + 46 8 311 590. E-mail: doduy.cuong@gmail.com (Received 30 September 2011; accepted 11 October 2011) Introduction Wide access to antiretroviral therapy (ART) has sub- stantially improved the prognosis of patients infected with human immunodeficiency virus type 1 (HIV-1) [1–3]. However, in resource-limited countries, early mortality has remained high after initiation of ART due to late presentation with advanced immunodefi- ciency [4–6]. Vietnam has an estimated HIV prevalence of 0.44% among adults aged 15–49 y [7]. By 2010, about 254,000 people were living with HIV, and 50,000 had died. Since 2005, ART programmes have been scaled up and the number of deaths caused by the acquired immune deficiency syndrome (AIDS) has been in rapid decline [7]. However, socio-eco- nomic barriers to ART access, such as stigma, drug abuse, and limited support from families and com- munities, remain for people living with HIV [8,9]. In addition, the high workload and limited qualifica- tions of health care providers jeopardize the quality of care [10]. Tuberculosis (TB) is one of the most common opportunistic infections (OIs) with a high mortality rate (28–29%) [11–13]. Several studies on epidemiological, social, and clinical assessments of HIV in Vietnam have been published recently [8–13]. However, information on survival, causes of death, ORIGINAL ARTICLE Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam DO DUY CUONG 1,2 , ANNA THORSON 1 , ANDERS SÖNNERBORG 3 , NGUYEN PHUONG HOA 4 , NGUYEN THI KIM CHUC 4 , HO DANG PHUC 5 & MATTIAS LARSSON 1,6 From the 1 Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, 2 Infectious Diseases Department, Bach Mai Hospital, Hanoi,Vietnam, 3 Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, 4 Hanoi Medical University, Hanoi,Vietnam, 5 Department of Probability and Mathematical Statistics, Institute of Mathematics, Hanoi,Vietnam, and 6 Oxford University Clinical Research Unit (OUCRU), Hanoi,Vietnam Abstract Background: There is a lack of knowledge on mortality and causes of death among human immunodeficiency virus (HIV)- infected patients after initiation of antiretroviral therapy (ART) in Vietnam. We investigated the mortality rate, risk factors, causes of death, and impact of enhanced adherence support on survival among 640 Vietnamese treatment-naïve HIV- infected patients receiving ART in a cluster randomized controlled trial. Methods: Patients in the intervention group received enhanced adherence from peer-supporters. Data were collected through medical records and a verbal autopsy questionnaire. We used Kaplan–Meier analysis to describe the survival trends and the Cox proportional hazard model to identify predic- tors of acquired immune deficiency syndrome (AIDS)-related deaths. Results: After a median follow-up of 15.2 months, there were 60 deaths, 73% of which occurred within 6 months. The mortality rate was 7.4/100 person-y and survival prob- ability was 91% after 1 y. There was no significant difference in mortality rate between the intervention and the control groups. At baseline, the predictive factors for AIDS-related death were age 35 y, clinical stage 3 or 4, body mass index (BMI) 18 kg/m 2 , CD4 count 100/ μl, haemoglobin level 100 g/l, and plasma viral load 100,000 copies/ml. Tuber- culosis (TB) was the most common cause of death (40%). Conclusions: Early deaths occurred after ART, and delay of ART caused a significant decrease in CD4 count and a high mortality. Adherence support had no impact on survival at the early stage of ART. Early ART initiation and intensive follow-up of patients during the first 6 months of ART are therefore necessary to reduce AIDS-related mortality. Keywords: Mortality , causes of death, ART , peer support, Vietnam Scandinavian Journal of Infectious Diseases, 2012; 44: 201–208 ISSN 0036-5548 print/ISSN 1651-1980 online © 2012 Informa Healthcare DOI: 10.3109/00365548.2011.631937 Scand J Infect Dis Downloaded from informahealthcare.com by Karolinska Institutet University Library on 03/19/12 For personal use only.