Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa
Abstract: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.
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: July 1, 2010
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