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

View/ Open
Date
2009Author
Miiro, George
Todd, Jim
Mpendo, Juliet
Watera, Christine
Munderi, Paula
Nakubulwa, Susan
Kaddu, Ismael
Rutebarika, Diana
Grosskurth, Heiner
Metadata
Show full item recordAbstract
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.
Collections
- Medical and Health Sciences [2894]