No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project

BMC Public Health

Research Article

David M. Moore¹  Frank Kaharuza²  Emmy Muramuzi²  Samuel Malamba²  Stephen Okoboi³  Celestin Bakanda³  Aggrey Egessa³  Paul John Ekwaru⁴  Racheal King⁵  James D. Campbell⁶ 

[1] BC Centre for Excellence in HIV/AIDS, Vancouver, Canada;University of British Columbia, Vancouver, Canada;Makerere University School of Public Health, Kampala, Uganda;The AIDS Support Organization-TASO, Headquarters, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda;University of Alberta, Edmonton, Canada;University of California, San Francisco, USA;University of Maryland School of Medicine, Baltimore, MD, USA;

关键词: Antiretroviral therapy;    Virologic failure;    Morbidity;    Mortality;    Sub-Saharan Africa;    Uganda;   

DOI  :  10.1186/s12889-016-2781-y

 received in 2015-10-16, accepted in 2016-01-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundWe compared clinical outcomes among HIV-infected participants receiving ART who were randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in Tororo, Uganda.MethodsBeginning in May 2003, participants with CD4 cell counts <250 cells/μL or WHO stage 3 or 4 disease were randomized to clinical monitoring alone, clinical monitoring plus quarterly CD4 cell counts (CD4-only); or clinical monitoring, quarterly CD4 cell counts and quarterly VL testing (CD4-VL). In 2007, individuals in clinical monitoring arm were re-randomized to the other two arms and all participants were followed until March 31, 2009. We used Cox Proportional Hazard models to determine if study arm was independently associated with the development of opportunistic infections (OIs) or death.ResultsWe randomized 1211 participants to the three original study arms and 331 surviving participants in the clinical monitoring arm were re-randomized to the CD4-VL and CD4 only arms. At enrolment the median age was 38 years and the median CD4 cell count was 134 cells/μL. Over a median of 5.2 years of follow-up, 37 deaths and 35 new OIs occurred in the VL-CD4 arm patients, 39 deaths and 42 new OIs occurred in CD4-only patients. We did not observe an association between monitoring arm and new OIs or death (AHR =1.19 for CD4-only vs. CD4-VL; 95 % CI 0.82–1.73).ConclusionWe found no differences in clinical outcomes associated with the addition of quarterly VL monitoring to quarterly CD4 cell count monitoring.

【 授权许可】

CC BY   
© Okoboi et al. 2016