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

Research Article

Luigia Elzi¹  Manuel Battegay¹  Hansjakob Furrer²  Eveline Geubbels³  Salim Abdulla³  Honoraty Urassa⁴  Patience L Kibatala⁵  Emmanuel G Mwaigomole⁶  Evarist Chiweka⁶  Erik Mossdorf⁷  Marcel Tanner⁸  Christoph Hatz⁸  Marcel Stoeckle⁹ 

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

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

[3]Ifakara Health Institute, Dar es Salaam, Tanzania

[4]Ifakara Health Institute, Ifakara, Tanzania

[5]St. Francis Designated District Hospital, Ifakara, Tanzania

[6]St. Francis Designated District Hospital, Ifakara, Tanzania

[7]Ifakara Health Institute, Ifakara, Tanzania

[8]St. Francis Designated District Hospital, Ifakara, Tanzania

[9]Ifakara Health Institute, Ifakara, Tanzania

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

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

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

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

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

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

DOI  :  10.1186/1471-2334-11-98

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

来源: Springer

【 摘 要 】

BackgroundData on combination antiretroviral therapy (cART) in remote rural African regions is increasing.MethodsWe 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.ResultsOverall, 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).ConclusionscART 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】

Unknown   
© Mossdorf et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.