Abstract
ObjectivesTo determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS).Design/SettingA 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/Participants35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51–2.41).Outcome MeasuresIncidence 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.ResultsThe 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.ConclusionsThe 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.
Highlights
During months 0–3 pulmonary tuberculosis was the most common condition diagnosed in adults and children aged 5–14 years (25.76) and oral candidiasis was the most common in children,5 years (25.79)
Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia
Efforts to scale up provision of anti-retroviral therapy (ART) in resource-limited settings (RLS) have dramatically increased over the past decade [1,2]
Summary
Efforts to scale up provision of anti-retroviral therapy (ART) in resource-limited settings (RLS) have dramatically increased over the past decade [1,2]. A vital role of such programs is diagnosis, treatment and prevention of HIV associated conditions which contribute significantly to morbidity and mortality in patients on ART in RLS [2,3,4,5]. In RLS there is a lack of data regarding the frequency and relative importance of common HIV associated conditions after commencement of ART. It is unclear whether there are differences in disease incidence rates between regions and age groups. This study aims to describe the incidence of WHO Stage 3 and 4 conditions for three years following ART initiation in patients attending Medecins Sans Frontieres (MSF) supported treatment programs in RLS and to examine how this is influenced by region and age
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
