Clinical illness as a marker for initiation of HIV antiretroviral therapy in a rural setting, Rakai, Uganda

Lisa A. Spacek, Ronald H. Gray, Maria J. Wawer, Nelson K. Sewankambo, David Serwadda, Fred Wabwire-Mangen, Noah Kiwanuka, Godfrey Kigozi, Fred Nalugoda, Thomas C. Quinn

Research output: Contribution to journalArticle

Abstract

The aim of this study is to assess whether HIV-related illness and World Health Organization (WHO) clinical stage can be used to guide initiation of antiretroviral therapy (ART) in rural Rakai District, Uganda. A retrospective cohort analysis of 910 HIV-seroprevalent individuals randomly sampled from a community cohort was conducted. The associations between HIV-related clinical illness and HIV viral loads >55,000 copies/mL and death were evaluated as a guide for initiation of ART. Reporting one or more HIV-related illnesses was associated with high specificity for identifying HIV viral load >55,000 copies/mL and predicting death within 30 months. There were more deaths in those with one symptom at baseline (16.3%) and two or more symptoms (25.0%) than in those reporting no symptoms (9.6%; P=0.001). HIV-related illness and WHO stage predicted disease progression. The specificity of clinical illness to predict viral load >55,000 copies/mL was high and could be used to rule in HIV disease requiring ART.

Original languageEnglish (US)
Pages (from-to)116-120
Number of pages5
JournalInternational Journal of STD and AIDS
Volume17
Issue number2
DOIs
StatePublished - Feb 1 2006

Keywords

  • AIDS care
  • Algorithms
  • Antiretroviral therapy
  • Resource-limited setting
  • Uganda

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Pharmacology (medical)
  • Infectious Diseases

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