No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
We compared clinical outcomes among HIV-infected participants receiving ART who were
randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in
Tororo, Uganda.
Methods: Beginning in May 2003, participants with CD4 cell counts <250 cells/μL or WHO stage 3 or 4 disease
were randomized to clinical monitoring alone, clinical monitoring plus quarterly CD4 cell counts (CD4-only); or
clinical monitoring, quarterly CD4 cell counts and quarterly VL testing (CD4-VL). In 2007, individuals in clinical
monitoring arm were re-randomized to the other two arms and all participants were followed until March 31, 2009.
We used Cox Proportional Hazard models to determine if study arm was independently associated with the
development of opportunistic infections (OIs) or death.
Results: We randomized 1211 participants to the three original study arms and 331 surviving participants in the
clinical monitoring arm were re-randomized to the CD4-VL and CD4 only arms. At enrolment the median age was
38 years and the median CD4 cell count was 134 cells/μL. Over a median of 5.2 years of follow-up, 37 deaths and
35 new OIs occurred in the VL-CD4 arm patients, 39 deaths and 42 new OIs occurred in CD4-only patients. We did
not observe an association between monitoring arm and new OIs or death (AHR =1.19 for CD4-only vs. CD4-VL;
95 % CI 0.82–1.73).
Conclusion: We found no differences in clinical outcomes associated with the addition of quarterly VL monitoring
to quarterly CD4 cell count monitoring.
Description
Keywords
Antiretroviral therapy, Virologic failure, Morbidity, Mortality, Sub-Saharan Africa, Uganda
Citation
Okoboi, S., Ekwaru, P. J., Campbell, J. D., Egessa, A., King, R., Bakanda, C., ... & Moore, D. M. (2015). No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project. BMC Public Health, 16(1), 1-8. DOI 10.1186/s12889-016-2781-y