To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS)

A d’Arminio Monforte

A Miranda

Andrea J. Curtis

AS Walker

B Castelnuovo

B Ledergerber

Catherine S. Marshall

CE Gonzalez

Daniel P. O’Brien

DJ Sloan

DR Hoover

Esther C. Casas

J Abadi

J Mermin

Jane Greig

JE Golub

JE Kaplan

JF Etard

Julian H. Elliot

K Buchacz

Leslie Shanks

M-L Newell

Marcio Silveria Da Fonseca

NJ Ives

Philipp Du Cros

R Zachariah

SD Lawn

Sten H. Vermund

Tim Spelman

VO Kasprowicz

W Manosuthi

English

PubMed

OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS). DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41). OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4). The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4). During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years) and children aged 5-14 years (25.76) and oral candidiasis was the most common in children <5 years (25.79). Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001). Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly after ART initiation. Access to appropriate disease prevention tools prior to ART, and early initiation of ART, are important for their prevention

Curtis, AJ

Marshall, CS

Spelman, T

Greig, J

Elliot, JH

Shanks, L

du Cros, P

Casas, EC

da Fonseca, MS

O'Brien, DP

University of Melbourne Institutional Repository

PLoS ONE

Incidence of WHO Stage 3 and 4 Conditions following Initiation of Anti-Retroviral Therapy in Resource Limited Settings

Curtis, Andrea

Marshall, Catherine

Spelman, Tim

Greig, Jane

Elliott, Julian

Shanks, Leslie

Du Cros, Philipp

Casas, Esther

Da Fonseca, Marcio

O'Brien, Daniel

Monash University Research Repository

Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings

To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS).A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010.35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51–2.41).Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations.The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4). The incidence of stage 3 and 4 conditions fell by over 97% between months 0–3 and months 25–36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4). During months 0–3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years) and children aged 5–14 years (25.76) and oral candidiasis was the most common in children <5 years (25.79). Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001). Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia.The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly after ART initiation. Access to appropriate disease prevention tools prior to ART, and early initiation of ART, are important for their prevention

Curtis Andrea J.

Marshall Catherine S.

Spelman Tim

Greig Jane

Elliot Julian H.

Shanks Leslie

Du Cros Philipp

Casas Esther C.

Da Fonseca Marcio Silveria

O’Brien Daniel P.

Public Library of Science (PLOS)

Andrea J Curtis

Catherine S Marshall

Julian H Elliot

Esther C Casas

Daniel P O'Brien

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Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

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Marshall, Catherine S

Elliot, Julian H

Casas, Esther C

Da Fonseca, Marcio Silveria

O'Brien, Daniel P

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Incidence of WHO stage 3 and 4 conditions following initiation of Anti-Retroviral Therapy in resource limited settings

Crossref

http://minerva-access.unimelb.edu.au/bitstream/11343/264572/1/PMC3527377.pdf

Incidence of WHO stage 3 and 4 conditions following initiation of Anti-Retroviral Therapy in resource limited settings

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