Skip to main content

Free Content Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa

Download Article:
(PDF 263.013671875 kb)
OBJECTIVES: A prospective cohort study was conducted among human immunodeficiency virus (HIV) infected in-patients with tuberculosis (TB) or other opportunistic infections (OIs) in South Africa to estimate subsequent antiretroviral therapy (ART) uptake and survival.

METHODS: Logistic regression modeling explored associations between baseline characteristics and starting ART, and ART exposure-adjusted incidence of death was estimated over 6 months of follow-up.

RESULTS: Among 49 participants enrolled, median CD4 cell count at hospital discharge was 42 cells/μl and the most common presenting OIs were TB (76%), Pneumocystis pneumonia (8%), chronic diarrhea (8%), cryptococcal meningitis (6%), and Toxoplasma gondii (4%). By 6 months, only 20 (45%) patients had initiated ART, and four (8%) were lost to follow-up. ART uptake was independently associated with previous use of traditional medicine (OR 7.2, 95%CI 1.4–55.1) and with less advanced HIV infection (baseline CD4 count per 50 cells/μl increase OR 1.4, 95%CI 0.9–2.2). A total of 14 (31%) patients died before initiating ART; the monthly incidence of death did not decrease over the 6-month interval.

CONCLUSION: The high mortality observed within the 6 months following hospitalization with TB or other acute OIs indicate that mechanisms are needed to expedite ART for patients after an acquired immune-deficiency syndrome defining illness.
No References
No Citations
No Supplementary Data
No Data/Media
No Metrics

Keywords: antiretroviral therapy; co-infection; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Doctors Without Borders USA, New York, New York, USA 2: McCord Hospital, Durban, South Africa 3: Harvard Medical School, Boston, Massachusetts, USA 4: Division of Infectious Disease and Geographic Medicine, Stanford University, Palo Alto, California, USA 5: Zoe-Life, Durban, South Africa 6: Section of Retroviral Therapeutics, Brigham and Women's Hospital, Boston, Massachusetts, USA 7: Centre for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA

Publication date: 2010-07-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more