Impact of Prior HAART Use on Clinical Outcomes in a Large Kenyan HIV Treatment Program

Abstract

Background HIV treatment programs in Africa typically approach all enrolling patients uniformly. Growing numbers of patients are antiretroviral experienced. Defining patients on the basis of antiretroviral experience may inform enrollment practices, particularly if medical outcomes differ. Methods Baseline and follow-up measures (CD4, weight change, and survival) were compared in a retrospective analysis between antiretroviral-naïve (ARV-N) and antiretroviral experience (ARV-E) patients enrolled at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya and followed between January 2004 and August 2006. Results 1,307 ARV-N and 962 ARV-E patients receiving highly active antiretroviral therapy (HAART) were followed for median of 9 months (interquartile range: 4-16 months). Compared to ARV-N, ARV-E had substantially higher CD4 count (median cells/mm3, 193 versus 95, P < 0.001) and weight (median kg, 62 versus 57, P < 0.001) at baseline, and lower rates of change in CD4 (-9.2 cells/mm3/month; 95% CI, -11.4 - -7.0) and weight (-0.24 kg/month; 95% CI, -0.35 - -0.14) over 12 months. Mortality was significantly higher in ARV-N than ARV-E (P = 0.001). Conclusions ARV-E patients form a growing group that differs significantly from ARV-N patients and requires a distinct approach from ARV-N clients. Systematic approaches to streamline care of ARV-E patients may allow focused attention on early ARV-N clients whose mortality risks are substantially higher.

Cervical Squamous Intraepithelial Lesions Among HIV-Positive Women on Antiretroviral Therapy in Kenya

“…Participants had received HAART for a median duration of 13 months (IQR, [8][9][10][11][12][13][14][15][16][17][18][19] at the time of Pap smear. Onehundred and seventy-one (64%) women were on a HAART regimen containing lamivudine (3TC), stavudine (d4T) and nevirapine (NVP) and 51 (19%) were on 3TC, d4T and efavirenz (EFV) ( Table 2).…”

“…In Zambia, although 76% of women examined reported receiving HAART, most had been taking it for less than 6 months. All of the women in this study had been on HAART for a median duration of 13 months (IQR, [8][9][10][11][12][13][14][15][16][17][18][19] with an observed prevalence of cervical pre-cancerous lesions that was comparable to studies with less HAART coverage and duration. Our findings suggest that cervical screening in HIV treatment programs in Africa will detect a substantial amount of cervical disease, even after prolonged HAART.…”

“…The study was a retrospective review of data collected from adult female patients who enrolled at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya between July 2006 and June 2007 and received free Pap smear screening. Clinic procedures at the Coptic Hope Center have been described elsewhere [11]. In brief, newly enrolled patients were tested with confirmatory ELISA HIV antibody tests, and CD4 counts were measured before HAART initiation and at every 6 months thereafter.…”

“…Data collection methods used at the Hope Center have been described elsewhere [11]. CD4 count results and weight information available within 45 days of a participant's cervical cancer screening visit were utilized in the analysis.…”

“…Median duration of antiretroviral therapy was 13 months [interquartile range (IQR), [8][9][10][11][12][13][14][15][16][17][18][19]. Abnormal cytology was found in 123 women (46%) with 70 women (26%) having low grade squamous intraepithelial lesions (LSIL), 22 (8%) high grade squamous intraepithelial lesions (HSIL), 30 (11%) atypical squamous cells of unknown significance (ASCUS) and 1 (0.4%) atypical glandular cells (AGC).…”