Clinical illness as a marker for initiation of HIV antiretroviral therapy in a rural setting, Rakai, Uganda.
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.
Spacek
Lisa A
LA
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. lspacek@jhmi.edu
Gray
Ronald H
RH
Wawer
Maria J
MJ
Sewankambo
Nelson K
NK
Serwadda
David
D
Wabwire-Mangen
Fred
F
Kiwanuka
Noah
N
Kigozi
Godfrey
G
Nalugoda
Fred
F
Quinn
Thomas C
TC
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
D019380:Anti-HIV Agents