title: Simple markers for initiating antiretroviral therapy among HIV-infected Ethiopians.
abstract: BACKGROUND
  We explored the relevance of simple markers (clinical or laboratory markers not requiring sophisticated laboratories) in the decision of initiation of therapy in resource-poor settings.
  
  
  METHODS
  Among HIV-infected Ethiopian cohort participants, simple markers predicting short-term death were examined using time-dependent Cox proportional hazards models. Timing of hypothetical treatment was compared between guidelines using the simple markers (based on presence of at least one marker), guidelines recommended by the United States Department of Health and Human Services (based on CD4 cell count and viral load), and guidelines for resource-limited settings recommended by the World Health Organization (WHO).
  
  
  RESULTS
  From February 1997 to August 2001, 35 deaths were recorded among 155 HIV-positive participants. Simple independent predictors of death were low body mass index, HIV-related conditions, anaemia, and lymphocyte count < 1500 x 10(6)/l. In such time as was covered by our study, 135 (87%) of 155 cohort participants would have had the same management under both the simple markers and the DHHS guidelines, i.e., would have been treated (n = 114, 74%) or not treated (n = 21, 14%). Of the 114 participants hypothetically treated under either set of guidelines, 91 (80%) would have started treatment at the same time. Application of the WHO guidelines for resource-limited settings (without CD4 cell counts) would have resulted in 11 participants dying without ever meeting a treatment indication during regular follow-up visits.
  
  
  CONCLUSIONS
  Simple markers for the initiation of highly active antiretroviral therapy were identified among HIV-infected Ethiopian patients. The validity of these markers for monitoring patients' improvement following therapy remains to be evaluated.
authors.affiliation: Ethio-Netherlands AIDS Research Project (ENARP), Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia.
authors.forename: Yared
authors.initials: Y
authors.lastname: Mekonnen
authors.forename: Nicole H
authors.initials: NH
authors.lastname: Dukers
authors.forename: Eduard
authors.initials: E
authors.lastname: Sanders
authors.forename: Wendelien
authors.initials: W
authors.lastname: Dorigo
authors.forename: Dawit
authors.initials: D
authors.lastname: Wolday
authors.forename: Ab
authors.initials: A
authors.lastname: Schaap
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000592:standards* / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006679:HIV Seropositivity / Q000097:blood; D015497:HIV-1; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D019562:Viral Load
chemical_list: D015415:Biomarkers