Improved antiretroviral treatment outcome in a rural African setting is associated with cART initiation at higher CD4 cell counts and better general health condition

BMC Infectious Diseases

Manuel Battegay²  Christoph Hatz¹  Hansjakob Furrer⁵  Marcel Tanner¹  Luigia Elzi²  Salim Abdulla⁶  Honoraty Urassa³  Eveline Geubbels⁶  Patience L Kibatala⁴  Evarist Chiweka³  Emmanuel G Mwaigomole³  Marcel Stoeckle²  Erik Mossdorf² 

[1]Swiss Tropical and Public Health Institute, University Basel, Basel, Switzerland

[2]Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

[3]Ifakara Health Institute, Ifakara, United Republic of Tanzania

[4]St. Francis Designated District Hospital, Ifakara, United Republic of Tanzania

[5]Division of Infectious Diseases, University Hospital and University of Berne, Berne, Switzerland

[6]Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania

关键词: Tanzania;    rural;    treatment outcome;    antiretroviral therapy;    HIV-1;   

Others  :  1175751
DOI  :  10.1186/1471-2334-11-98

 received in 2010-09-23, accepted in 2011-04-19,  发布年份 2011

【 摘 要 】

Background

Data on combination antiretroviral therapy (cART) in remote rural African regions is increasing.

Methods

We assessed prospectively initial cART in HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. We estimated risk factors of death or loss to follow-up by Cox regression during the first 12 months of cART.

Results

Overall, 1,463 individuals initiated cART, which was nevirapine-based in 84.6%. The median age was 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count was 131 cells/μl and 24.8% had WHO stage 4. Median CD4 cell count increased by 61 and 130 cells/μl after 6 and 12 months, respectively. 215 (14.7%) patients modified their treatment, mostly due to toxicity (56%), in particular polyneuropathy and anemia. Overall, 129 patients died (8.8%) and 189 (12.9%) were lost to follow-up. In a multivariate analysis, low CD4 cells at starting cART were associated with poorer survival and loss to follow-up (HR 1.77, 95% CI 1.15-2.75, p = 0.009; for CD4 <50 compared to >100 cells/μl). Higher weight was strongly associated with better survival (HR 0.63, 95% CI 0.51-0.76, p < 0.001 per 10 kg increase).

Conclusions

cART initiation at higher CD4 cell counts and better general health condition reduces HIV related mortality in a rural African setting. Efforts must be made to promote earlier HIV diagnosis to start cART timely. More research is needed to evaluate effective strategies to follow cART at a peripheral level with limited technical possibilities.

【 授权许可】

   
2011 Mossdorf et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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