BACKGROUND: We explored the relevance of simple markers (clinical or laboratory markers not requiring sophisticated laboratories) in the decision of initiation of therapy in resource-poor settings. METHODS: Among HIV-infected Ethiopian cohort participants, simple markers predicting short-term death were examined using time-dependent Cox proportional hazards models. Timing of hypothetical treatment was compared between guidelines using the simple markers (based on presence of at least one marker), guidelines recommended by the United States Department of Health and Human Services (based on CD4 cell count and viral load), and guidelines for resource-limited settings recommended by the World Health Organization (WHO). RESULTS: From February 1997 to August 2001, 35 deaths were recorded among 155 HIV-positive participants. Simple independent predictors of death were low body mass index, HIV-related conditions, anaemia, and lymphocyte count < 1500 x 106/l. In such time as was covered by our study, 135 (87%) of 155 cohort participants would have had the same management under both the simple markers and the DHHS guidelines, i.e., would have been treated (n = 114, 74%) or not treated (n = 21, 14%). Of the 114 participants hypothetically treated under either set of guidelines, 91 (80%) would have started treatment at the same time. Application of the WHO guidelines for resource-limited settings (without CD4 cell counts) would have resulted in 11 participants dying without ever meeting a treatment indication during regular follow-up visits. CONCLUSION: Simple markers for the initiation of highly active antiretroviral therapy were identified among HIV-infected Ethiopian patients. The validity of these markers for monitoring patients' improvement following therapy remains to be evaluated.
BACKGROUND: We explored the relevance of simple markers (clinical or laboratory markers not requiring sophisticated laboratories) in the decision of initiation of therapy in resource-poor settings. METHODS: Among HIV-infected Ethiopian cohort participants, simple markers predicting short-term death were examined using time-dependent Cox proportional hazards models. Timing of hypothetical treatment was compared between guidelines using the simple markers (based on presence of at least one marker), guidelines recommended by the United States Department of Health and Human Services (based on CD4 cell count and viral load), and guidelines for resource-limited settings recommended by the World Health Organization (WHO). RESULTS: From February 1997 to August 2001, 35 deaths were recorded among 155 HIV-positive participants. Simple independent predictors of death were low body mass index, HIV-related conditions, anaemia, and lymphocyte count < 1500 x 106/l. In such time as was covered by our study, 135 (87%) of 155 cohort participants would have had the same management under both the simple markers and the DHHS guidelines, i.e., would have been treated (n = 114, 74%) or not treated (n = 21, 14%). Of the 114 participants hypothetically treated under either set of guidelines, 91 (80%) would have started treatment at the same time. Application of the WHO guidelines for resource-limited settings (without CD4 cell counts) would have resulted in 11 participants dying without ever meeting a treatment indication during regular follow-up visits. CONCLUSION: Simple markers for the initiation of highly active antiretroviral therapy were identified among HIV-infected Ethiopian patients. The validity of these markers for monitoring patients' improvement following therapy remains to be evaluated.
Authors: Loukia Aketi; Pierre M Tshibassu; Patrick K Kayembe; Faustin Kitetele; Samuel Edidi; Mathilde B Ekila; Roger Wumba; François B Lepira; Michel N Aloni Journal: Pathog Glob Health Date: 2015-07-17 Impact factor: 2.894
Authors: H Byakwaga; K Petoumenos; J Ananworanich; F Zhang; M A Boyd; T Sirisanthana; P C K Li; C Lee; C V Mean; V Saphonn; S F S Omar; S Pujari; P Phanuphak; P L Lim; N Kumarasamy; Y M A Chen; T P Merati; S Sungkanuparph; R Ditangco; S Oka; G Tau; J Zhou; M G Law; S Emery Journal: J Int Assoc Provid AIDS Care Date: 2013-02-19
Authors: Christopher R Sudfeld; Sheila Isanaka; Said Aboud; Ferdinand M Mugusi; Molin Wang; Guerino E Chalamilla; Wafaie W Fawzi Journal: J Infect Dis Date: 2013-01-14 Impact factor: 5.226
Authors: Philippa M Musoke; Alicia M Young; Maxensia A Owor; Irene R Lubega; Elizabeth R Brown; Francis A Mmiro; Lynne M Mofenson; J Brooks Jackson; Mary Glenn Fowler; Laura A Guay Journal: J Acquir Immune Defic Syndr Date: 2008-10-01 Impact factor: 3.731
Authors: E M Molyneux; M Tembo; K Kayira; L Bwanaisa; J Mweneychanya; A Njobvu; H Forsyth; S Rogerson; A L Walsh; M E Molyneux Journal: Arch Dis Child Date: 2003-12 Impact factor: 3.791
Authors: Opemipo O Johnson; Daniel K Benjamin; Daniel K Benjamin; Werner Schimana; L Gayani Tillekeratne; John A Crump; Keren Z Landman; Grace D Kinabo; Blandina Mmbaga; Levina J Msuya; John F Shao; Mark E Swai; Coleen K Cunningham Journal: Pediatr Infect Dis J Date: 2009-06 Impact factor: 2.129
Authors: Olivia Keiser; Kathryn Anastos; Mauro Schechter; Eric Balestre; Landon Myer; Andrew Boulle; David Bangsberg; Hapsatou Touré; Paula Braitstein; Eduardo Sprinz; Denis Nash; Mina Hosseinipour; François Dabis; Margaret May; Martin W G Brinkhof; Matthias Egger Journal: Trop Med Int Health Date: 2008-03-27 Impact factor: 2.622
Authors: Christopher R Sudfeld; Sheila Isanaka; Ferdinand M Mugusi; Said Aboud; Molin Wang; Guerino E Chalamilla; Edward L Giovannucci; Wafaie W Fawzi Journal: Am J Clin Nutr Date: 2013-05-01 Impact factor: 7.045