Reduced morbidity and mortality in the first year after initiating highly active anti-retroviral therapy (HAART) among Ugandan adults
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Date
2009
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine & International Health
Abstract
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.
Description
Keywords
Highly active anti-retroviral therapy, Cotrimoxazole prophylaxis, Morbidity, Adverse events
Citation
Miiro, G., Todd, J., Mpendo, J., Watera, C., Munderi, P., Nakubulwa, S., ... & Grosskurth, H. (2009). Reduced morbidity and mortality in the first year after initiating highly active anti‐retroviral therapy (HAART) among Ugandan adults. Tropical Medicine & International Health, 14(5), 556-563. doi:10.1111/j.1365-3156.2009.02259.x