Improved antiretroviral treatment outcome in a rural African setting is associated with cART initiation at higher CD4 cell counts and better general health condition

摘要: Data on combination antiretroviral therapy (cART) in remote rural African regions is increasing. We assessed prospectively initial cART HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. estimated risk factors of death or loss follow-up Cox regression during the first 12 months cART. Overall, 1,463 individuals initiated cART, which nevirapine-based 84.6%. The median age 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count 131 cells/μl and 24.8% WHO stage 4. increased 61 130 after 6 months, respectively. 215 (14.7%) patients modified their treatment, mostly due toxicity (56%), particular polyneuropathy anemia. 129 died (8.8%) 189 (12.9%) lost follow-up. In a multivariate analysis, low cells starting associated with poorer survival (HR 1.77, 95% CI 1.15-2.75, p = 0.009; for 100 cells/μl). Higher weight strongly better 0.63, 0.51-0.76, < 0.001 per 10 kg increase). initiation higher counts general health condition reduces HIV related mortality setting. Efforts must be made promote earlier diagnosis start timely. More research needed evaluate effective strategies follow peripheral level limited technical possibilities.