Abstract
BackgroundSouth Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated.ObjectivesTo determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time.MethodsThis is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province.ResultsA total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R2 of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9–51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART > 6 months (36.7%), and the difference was statistically significant, P < 0.01.ConclusionART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL.
Highlights
In 2018, it was estimated that 21 million of a global total of 38 million persons living with HIV (PLWH) live in Eastern and Southern Africa.[1]
In 2015, South Africa (SA) adopted the 90-90-90% targets of the Joint United Nations Programme on AIDS (UNAIDS). These aimed to ensure that 90% of the population were aware of their HIV status, 90% of those living with HIV would be on Antiretroviral treatment (ART) and 90% of the latter be virally suppressed by 2020.8,9 In 2016, the ‘Universal Test and Treat’ (UTT) programme was implemented in SA, and ART was offered to all PLWH regardless of their CD4+ level.[13]
Thereafter, a further 171 patients diagnosed with cytomegalovirus retinitis (CMVR) were excluded (Figure 3), with a total of 383 participants being included in this study (Table 1)
Summary
In 2018, it was estimated that 21 million of a global total of 38 million persons living with HIV (PLWH) live in Eastern and Southern Africa.[1]. With South Africa (SA) being the epicentre of HIV, the estimated numbers of PLWH have increased from 3.8 million in 20022 to 7.64 million in 2020.3 Antiretroviral treatment (ART) has been used in the United States (US) and Europe since 1996;4,5,6,7 the public sector in SA was only able to access therapy from 2004, and only for those with a CD4+ count ≤ 200 cells/μL.[8,9,10]. South Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004 The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated
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