Reduced morbidity and mortality in the first year after initiating highly active anti‐retroviral therapy (HAART) among Ugandan adults

Abstract

Summaryobjective To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility.methods Between 1999 and 2006, we collected morbidity data from a community-based cohort of HAART-eligible patients, comparing patients initiating HAART and those non-HAART. Patients aged 15 years or older visited the clinic every 6 months and when ill. Baseline data on patients' characteristics, WHO stage, haemoglobin and CD4+ T-cell counts, along with follow-up data on morbidity (new, recurrent and drug-related), were collected for the first year after initiating HAART or becoming HAART-eligible. We estimated the overall effect of HAART on morbidity; adjusted for the effect of cotrimoxazole prophylaxis by Mantel-Haenszel methods. A negative binomial regression model was used to assess rate ratios (RR) after adjustment for other confounders, including cotrimoxazole.results A total of 219 HAART patients (median age 37 years; 73% women; 82% using cotrimoxazole prophylaxis, median haemoglobin 11.7 g ⁄ dl and median CD4+ 131 cells ⁄ ll) experienced 94 events in 127 person-years. 616 non-HAART patients (median age 33 years; 70% women; 26% using cotrimoxazole prophylaxis, median haemoglobin 11.2 g ⁄ dl and median CD4+ 130 cells ⁄ ll) experienced 862 events in 474 person-years. The overall morbidity during the first year of HAART was 80% lower than among non-HAART patients (adjusted RR = 0.20, 95% CI: 0.12-0.34). Cotrimoxazole prophylaxis also reduced morbidity (adjusted RR = 0.65, 95% CI: 0.45-0.94).conclusion These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis.keywords highly active anti-retroviral therapy, cotrimoxazole prophylaxis, morbidity, adverse events

Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis

“…Of the nine, seven reported an estimate for the effect of cotrimoxazole on mortality, [28][29][30][31][32][33][34] whereas three reported an estimate for the effect on morbidity. 28,35,36 Two studies also reported the preventive effect on malaria. 28,36 Assessment of publication bias indicated that three studies [28][29][30] were of high methodological quality, while the other six [31][32][33][34][35][36] were of moderate methodological quality (Table 4, available at: http://www.who.…”

“…28,35,36 Two studies also reported the preventive effect on malaria. 28,36 Assessment of publication bias indicated that three studies [28][29][30] were of high methodological quality, while the other six [31][32][33][34][35][36] were of moderate methodological quality (Table 4, available at: http://www.who. int/bulletin/volumes/90/2/11-093260).…”

“…In addition, Walker et al also reported that cotrimoxazole reduced the odds of new or recurrent WHO clinical stage 3 or 4 disease events (OR: 0.85; 95% CI: 0.74-0.98), 28 whereas Miiro et al reported a trend towards lower all-cause morbidity (relative risk, RR: 0.66; 95% CI: 0.41-1.06), although all-cause morbidity was undefined. 35 A trial identified during the review of references of studies that met the inclusion criteria found that the risk of both malaria (RR: 0.04; 95% CI: 0.01-0.17) and diarrhoea (RR: 0.56; 95% CI: 0.43-0.77) was lower among Ugandans on ART who were randomized to cotrimoxazole than among those who were not. 36 The patients had been receiving ART for a mean of 3.7 years, their median CD4 cell count was 489 cells/µL and 94% had a viral load < 400 RNA copies/mL.…”

“…The summary estimate of the effect of cotrimoxazole on the incidence rate of death derived using a random-effects model was 0.42 (95% confidence interval, CI: 0.29-0.61). Survival was increased by either continuing cotrimoxazole at ART initiation, 29,[33][34][35] initiating cotrimoxazole at the same time as ART 29,34 or initiating cotrimoxazole when the patient was stable on ART.…”

Association between chronic hepatitis C and hepatitis C/HIV co-infection and the development of colorectal adenomas

“…Historically, HIV/AIDS infection has been associated with many opportunistic malignancies such as Kaposi's sarcoma; however, since the introduction of highly active antiretroviral therapy (HAART), the incidence of opportunist neoplasm in this population has decreased, along with an increase in life expectancy (7). As a result, the incident of non-AIDSdefining-malignancy (NADM) has increased.…”