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

Mossdorf, Erik; Stoeckle, Marcel; Mwaigomole, Emmanuel G; Chiweka, Evarist; Kibatala, Patience L; Geubbels, Eveline; Urassa, Honoraty; Abdulla, Salim; Elzi, Luigia; Tanner, Marcel; Furrer, Hansjakob; Hatz, Christoph; Battegay, Manuel (2011). 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, 11, p. 98. London: BioMed Central 10.1186/1471-2334-11-98

[img]
Preview
Text
1471-2334-11-98.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (264kB) | Preview

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Furrer, Hansjakob

ISSN:

1471-2334

Publisher:

BioMed Central

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:24

Last Modified:

18 Dec 2014 20:09

Publisher DOI:

10.1186/1471-2334-11-98

PubMed ID:

21504595

Web of Science ID:

000291227900001

BORIS DOI:

10.7892/boris.8255

URI:

https://boris.unibe.ch/id/eprint/8255 (FactScience: 213771)

Actions (login required)

Edit item Edit item
Provide Feedback