title: Clinical illness as a marker for initiation of HIV antiretroviral therapy in a rural setting, Rakai, Uganda.
abstract: The aim of this study is to assess whether HIV-related illness and World Health Organization (WHO) clinical stage can be used to guide initiation of antiretroviral therapy (ART) in rural Rakai District, Uganda. A retrospective cohort analysis of 910 HIV-seroprevalent individuals randomly sampled from a community cohort was conducted. The associations between HIV-related clinical illness and HIV viral loads >55,000 copies/mL and death were evaluated as a guide for initiation of ART. Reporting one or more HIV-related illnesses was associated with high specificity for identifying HIV viral load >55,000 copies/mL and predicting death within 30 months. There were more deaths in those with one symptom at baseline (16.3%) and two or more symptoms (25.0%) than in those reporting no symptoms (9.6%; P = 0.001).HIV-related illness and WHO stage predicted disease progression. The specificity of clinical illness to predict viral load >55,000 copies/mL was high and could be used to rule in HIV disease requiring ART.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. lspacek@jhmi.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Spacek
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000465:Algorithms; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology / Q000821:virology; D015497:HIV-1; D006801:Humans; D012189:Retrospective Studies; D012423:Rural Health; D014454:Uganda; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents