If you are experiencing problems downloading PDF or HTML fulltext, our helpdesk recommend clearing your browser cache and trying again. If you need help in clearing your cache, please click here . Still need help? Email help@ingentaconnect.com

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

 Download
(PDF 263kb)
 
Download Article:

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.

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: July 1, 2010

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
  • ingentaconnect is not responsible for the content or availability of external websites
Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect 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