Simple markers for initiating antiretroviral therapy among HIV-infected Ethiopians.
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.
Mekonnen
Yared
Y
Ethio-Netherlands AIDS Research Project (ENARP), Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia.
Dukers
Nicole H
NH
Sanders
Eduard
E
Dorigo
Wendelien
W
Wolday
Dawit
D
Schaap
Ab
A
Geskus
Ronald B
RB
Coutinho
Roel A
RA
Fontanet
Arnaud
A
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
D015415:Biomarkers