ArticleBMC infectious diseases2011
Improved antiretroviral treatment outcome in a rural African setting is associated with cART initiation at higher CD4 cell counts and better general health condition.
Article in BMC infectious diseases, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Marked sex differences in all-cause mortality on antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis.Journal of the International AIDS Society · 2016Pooled it
- Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013.Journal of acquired immune deficiency syndromes (1999) · 2015Pooled it
- Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review.AIDS and behavior · 2014Pooled it
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- An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China.Scientific reports · 2019Article
- Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.AIDS (London, England) · 2017Article
- Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: A Systematic Review.AIDS research and treatment · 2017Review
- Cryptococcal Antigenemia in Immunocompromised Human Immunodeficiency Virus Patients in Rural Tanzania: A Preventable Cause of Early Mortality.Open forum infectious diseases · 2015Article
- Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study.BMC infectious diseases · 2015Article
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- Increases in regimen durability associated with the introduction of tenofovir at a large public-sector clinic in Johannesburg, South Africa.Journal of the International AIDS Society · 2013Article
- Prevalence of drug resistance mutations and HIV type 1 subtypes in an HIV type 1-infected cohort in rural Tanzania.AIDS research and human retroviruses · 2013Article
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- Viral hepatitis and rapid diagnostic test based screening for HBsAg in HIV-infected patients in rural Tanzania.PloS one · 2013Article
- Article
- Assessment at antiretroviral clinics during TB treatment reduces loss to follow-up among HIV-infected patients.PloS one · 2012Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundData on combination antiretroviral therapy (cART) in remote rural African regions is increasing.
methodsWe assessed prospectively initial cART in HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. We estimated risk factors of death or loss to follow-up by Cox regression during the first 12 months of cART.
resultsOverall, 1,463 individuals initiated cART, which was nevirapine-based in 84.6%. The median age was 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count was 131 cells/μl and 24.8% had WHO stage 4. Median CD4 cell count increased by 61 and 130 cells/μl after 6 and 12 months, respectively. 215 (14.7%) patients modified their treatment, mostly due to toxicity (56%), in particular polyneuropathy and anemia. Overall, 129 patients died (8.8%) and 189 (12.9%) were lost to follow-up. In a multivariate analysis, low CD4 cells at starting cART were associated with poorer survival and loss to follow-up (HR 1.77, 95% CI 1.15-2.75, p=0.009; for CD4<50 compared to >100 cells/μl). Higher weight was strongly associated with better survival (HR 0.63, 95% CI 0.51-0.76, p<0.001 per 10 kg increase).
conclusionscART initiation at higher CD4 cell counts and better general health condition reduces HIV related mortality in a rural African setting. Efforts must be made to promote earlier HIV diagnosis to start cART timely. More research is needed to evaluate effective strategies to follow cART at a peripheral level with limited technical possibilities.
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