Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis.PLoS medicine · 2021Pooled it
- Biomarkers of mortality in adults and adolescents with advanced HIV in sub-Saharan Africa.Nature communications · 2024Trial
- Routine versus Targeted Viral Load Strategy among Patients Starting Antiretroviral in Hanoi, Vietnam.Journal of the International AIDS Society · 2019Trial
- Raltegravir-intensified initial antiretroviral therapy in advanced HIV disease in Africa: A randomised controlled trial.PLoS medicine · 2018Trial
- Outcomes of the Three-month Weekly Isoniazid With Rifapentine (3HP) Versus the Six-month Isoniazid Preventive Therapy (6H) Among People Newly Enrolled in HIV Care in Western Kenya.Open forum infectious diseases · 2026Article
- Predictive Value of C-reactive Protein for Hospitalization and Mortality Among People With Advanced HIV Disease in Uganda Receiving the World Health Organization-recommended Package of Care.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Retention in care and viral suppression in people living with HIV and chronic hepatitis B in Maputo City, Mozambique: a prospective cohort study.Scientific reports · 2026Article
- Characteristics of Individuals With Advanced HIV Disease and Risk Factors for Mortality in a Contemporary Cohort in South Africa.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study.BMC infectious diseases · 2025Article
- Clinical impact and cost-effectiveness of the WHO-recommended advanced HIV disease package of care.The Lancet. Global health · 2025Article
- Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries-an extension study of eight countries.AIDS research and therapy · 2025Article
- Implementation of the advanced HIV disease package of care using a public health approach: lessons from Nigeria.BMC public health · 2024Observational
- Prevalence, Predictors, and Outcomes of HIV Care in HIV-Positive Clients Entering HIV Care With Advanced HIV Disease in Sub-Saharan Africa 2010-2022: Systematic Review and Meta-Analysis.Health science reports · 2024Article
- Observational
- Clinical characteristics and morbidity among hospitalized adults with advanced HIV disease in Uganda during 'test and treat' era.PLOS global public health · 2023Article
- Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the "treat all" era: a retrospective cohort study from rural Rwanda.BMC infectious diseases · 2022Article
- Effect of Mass Treatment with Azithromycin on Causes of Death in Children in Malawi: Secondary Analysis from the MORDOR Trial.The American journal of tropical medicine and hygiene · 2020Article
- Prospective International Study of Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome and Death in People Living With Human Immunodeficiency Virus and Severe Lymphopenia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Addressing advanced HIV disease and mortality in global HIV programming.AIDS research and therapy · 2020Review
- The cost-effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa.Journal of the International AIDS Society · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 12 institutions in 6 countries.
Funding
Abstract
Background: In sub-Saharan Africa, 20%-25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity. Methods: Participants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non-mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azithromycin-responsive infections, other events, and unknown. Results: Median pre-ART CD4 count was 37 cells/µL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-responsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2). Conclusions: Enhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease. Clinical Trials Registration: ISRCTN43622374.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.