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The Independent Effect of Highly Active Antiretroviral Therapy on Severe Opportunistic Disease Incidence and Mortality in HIV-infected Adults in Côte d’Ivoire
- Source :
- Antiviral Therapy, Antiviral Therapy, International Medical Press, 2007, 12 ((4)), pp.543-51, Scopus-Elsevier
- Publication Year :
- 2007
-
Abstract
- Background Studies in developed countries have shown highly active antiretroviral therapy (HAART) decreases incidence of severe opportunistic diseases (ODs) in HIV-infected patients beyond that which is expected from changes in CD4+T-cell count. Objective To estimate the independent impact of HAART on reducing ODs and mortality in Côte d'Ivoire. Methods Within two longitudinal studies of HIV-infected adults (1996–2003), we identified time on ‘cotrimoxazole alone’ and ‘HAART plus cotrimoxazole’. WHO stage 3–4 defining events and severe malaria were divided into those preventable and not preventable with cotrimoxazole. Incidence of ODs by CD4 count stratum was estimated using incidence density analysis. CD4+ T-cell count at time of OD was estimated using linear interpolation. Using Poisson regression, we estimated the effect of HAART on OD incidence and mortality by CD4 count stratum. Results Totals of 446 and 135 adults were followed during 6,216 and 3,412 person-months in the cotrimoxazole alone and HAART plus cotrimoxazole periods, respectively. There was a CD4+ T-cell-independent risk reduction for ODs and mortality during the HAART plus cotrimoxazole period compared with cotrimoxazole alone, which varied by time on HAART, CD4 count stratum and OD type. It was mainly seen after 6 months on HAART and for ODs not preventable by cotrimoxazole. The HAART effect differed significantly by CD4 count stratum ( P=0.02), but was significant in all strata after 6 months on HAART. Conclusions In these sub-Saharan African adults, HAART initiation reduced ODs and mortality beyond that which was expected through the HAART-induced CD4+ T-cell increase. Further studies should examine practical implications of this independent ‘HAART effect’ on clinical outcomes in patients on HAART.
- Subjects :
- medicine.medical_specialty
Pediatrics
Opportunistic infection
AIDS-Related Opportunistic Infections
HIV Infections
Severity of Illness Index
Article
Pharmacotherapy
Acquired immunodeficiency syndrome (AIDS)
Anti-Infective Agents
Antiretroviral Therapy, Highly Active
Epidemiology
Trimethoprim, Sulfamethoxazole Drug Combination
medicine
Humans
Pharmacology (medical)
Poisson Distribution
[SHS.ECO] Humanities and Social Sciences/Economics and Finance
Sida
Pharmacology
biology
business.industry
Incidence (epidemiology)
Incidence
Bacterial Infections
medicine.disease
biology.organism_classification
[SHS.ECO]Humanities and Social Sciences/Economics and Finance
CD4 Lymphocyte Count
Malaria
Infectious Diseases
Cote d'Ivoire
Mycoses
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
Immunology
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Drug Therapy, Combination
Viral disease
business
Toxoplasmosis
Subjects
Details
- Language :
- English
- ISSN :
- 13596535
- Database :
- OpenAIRE
- Journal :
- Antiviral Therapy, Antiviral Therapy, International Medical Press, 2007, 12 ((4)), pp.543-51, Scopus-Elsevier
- Accession number :
- edsair.doi.dedup.....b6ff928af232c342d9eddc9e23f71547