A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor countries

Colebunders, Robert; Moses, Kamya; Liu, John; Shihab, Hasan M; Semitala, Fred C.; Lutwama, Fred; Bakeera-Kitaka, Sabrina; Lynen, Lutgarde; Spacek, Lisa A.; Reynolds, Steven J.; Quinn, Thomas C.; Viner, Brant L.; Mayanja‐Kizza, Harriet

doi:10.1016/s1473-3099(05)70327-3

Cited by 57 publications

(58 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to the opinion of some authors [29,30], our data indicate that longitudinal viral load testing is possible in developing countries. In our opinion, viral load testing plays a significant role in clinical decision-making during HAART.…”

Section: Discussioncontrasting

confidence: 99%

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Barth

Meer

Hoepelman

et al. 2008

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

The purpose of this study was to assess the oneyear efficacy of highly active antiretroviral therapy (HAART) administered by general practitioners in a primary care community clinic in rural South Africa. We performed an observational cohort study of 675 treatmentnaïve human immunodeficiency virus (HIV)-infected patients (including 66 children) who began HAART at least 12 months prior to the data analyses. Throughout treatment, the CD4+ T-cell count (percentage of CD4+ Tcells in children) and plasma HIV-RNA level were determined and the patient's weight was recorded. The primary outcome was mortality. Secondary outcomes were viral suppression, immunological response, and weight gain. One year after the start of HAART, 100 of the 675 (15%) patients were lost to follow-up and 119 patients (18%), including six children, died. Mortality was highest during the first few months of treatment. Based on an ontreatment analysis at one year after the start of therapy, 83% of adults and 71% of children had a viral load <400 copies/ ml; the viral load was <50 copies/ml in 70% of adults and 61% of children. At one year, the mean CD4+ T-cell count in adults had increased by 236/mm 3 , and the mean body mass index (BMI) had increased by 3.5 kg/m 2 . In children, the mean CD4% had increased by 17.6. A low Karnofsky score and a low baseline CD4+ T-cell count were independently associated with death. In addition to these factors, a low baseline BMI and gender were predictive of a poor immunological outcome. Our study shows that adequately monitored HIV/acquired immunodeficiency syndrome (AIDS) care administered by general practitioners and their staff is feasible and leads to good results in a rural, primary care center in sub-Saharan Africa. In order to achieve even better results, early mortality should be reduced and efforts should be made to start HAART earlier.

show abstract

Section: Discussioncontrasting

confidence: 99%

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Barth

Meer

Hoepelman

et al. 2008

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

show abstract

“…[11]. WHO guidelines report that the appearance of new or recurrent WHO clinical stage 3 and 4 conditions beyond 24 weeks after initiation of therapy suggests treatment failure [9].…”

Section: Four Clinical Stagesmentioning

confidence: 99%

“…Early identification and treatment is crucial to reduce transmission of the virus, but many people remain unaware of their HIV status during the crucial early months of infection when transmission risk is high, secondary to elevated levels of viremia [3]. Monitoring systems that do not rely on laboratory techniques are also needed in resource-limited settings to monitor the increasing numbers of patients on antiretroviral medications [9]. The Revised WHO HIV/AIDS Clinical Staging System is intended for baseline assessment of patients and for use in provision of ongoing care.…”

mentioning

confidence: 99%

The WHO Clinical Staging System for HIV/AIDS

Weinberg

Kovarik²

2010

AMA Journal of Ethics

View full text Add to dashboard Cite

“…[4][5][6][7][8][9] However, the determinants of weight evolution at later stages, particularly after the first year of ART, and its clinical significance remain poorly understood and there is limited published literature on this subject. With regards to ART, weight loss after the first year of stavudinecontaining ART could occur due to poor adherence, treatment failure 10,[11][12][13] and lipoatrophy, [14][15][16] the latter having been shown to occur frequently in several African countries. [14][15][16] Although never specifically addressed, several studies suggest a potential association of lipoatrophy with weight loss.…”

Section: Introductionmentioning

confidence: 99%

Weight loss after the first year of stavudine-containing antiretroviral therapy and its association with lipoatrophy, virological failure, adherence and CD4 counts at primary health care level in Kigali, Rwanda

Griensven

Zachariah

Mugabo

et al. 2010

Transactions of the Royal Society of Tropical Medicine and Hygi

View full text Add to dashboard Cite

CitationWeight loss after the first year of stavudine-containing antiretroviral therapy and its association with lipoatrophy, virological failure, adherence and CD4 counts at primary health care level in Kigali, Rwanda. 2010, 104 (12) a b s t r a c tThis study was conducted among 609 adults on stavudine-based antiretroviral treatment (ART) for at least one year at health center level in Kigali, Rwanda to (a) determine the proportion who manifest weight loss after one year of ART (b) examine the association between such weight loss and a number of variables, namely: lipoatrophy, virological failure, adherence and on-treatment CD4 count and (c) assess the validity and predictive values of weight loss to identify patients with lipoatrophy. Weight loss after the first year of ART was seen in 62% of all patients (median weight loss 3.1 kg/year). In multivariate analysis, weight loss was significantly associated with treatment-limiting lipoatrophy (adjusted effect/kg/year -2.0 kg, 95% confidence interval -0.6;-3.4 kg; P < 0.01). No significant association was found with virological failure or adherence. Higher on-treatment CD4 cell counts were protective against weight loss. Weight loss that was persistent, progressive and/or chronic was predictive of lipoatrophy, with a sensitivity and specificity of 72% and 77%, and positive and negative predictive values of 30% and 95%. In low-income countries, measuring weight is a routine clinical procedure that could be used to filter out individuals with lipoatrophy on stavudine-based ART, after alternative causes of weight loss have been ruled out.

show abstract

A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor countries

Cited by 57 publications

References 63 publications

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

The WHO Clinical Staging System for HIV/AIDS

Weight loss after the first year of stavudine-containing antiretroviral therapy and its association with lipoatrophy, virological failure, adherence and CD4 counts at primary health care level in Kigali, Rwanda

Contact Info

Product

Resources

About