Decreasing trends of bacteraemia among HIV-infected Ugandan adults: incidence, aetiology, clinical outcomes and effect of antiretroviral therapy in a semi-urban setting (2000–2008)
Loading...
Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine & International Health
Abstract
To investigate the effect of antiretroviral therapy on trends of incidence, aetiology and
clinical outcomes of bacteraemia among HIV-infected Ugandans in a semi-urban setting.
methods A cohort of HIV-1-infected Ugandans aged 15 or older was followed from 2000 to 2008.
Clinical, haematological and immunological measurements were taken at 6-monthly visits. Additionally,
patients reported to outpatient clinics whenever they were ill. Patients with elevated axillary temperature
above 37.4 C consistently triggered clinical assessment (with mandatory blood cultures) and empirical
management protocol. Daily cotrimoxazole prophylaxis and highly active antiretroviral therapy
(HAART) were introduced stepwise to eligible patients in August 2000 and February 2003, respectively.
We compared the rates of bacteraemia across five calendar periods using random-effects Poisson
regression for the effect of HAART at the population level.
results A total of 246 bacteraemia episodes (including multiple episodes) were documented among
188 individuals (crude incidence: 42.4 events per 1000 person-years; 95% CI: 35.0, 51.4). The most
common species isolated was Streptococcus pneumoniae. After adjustment for current age, clinical
characteristics at enrolment (CD4+ T-cell counts and WHO stage) and time since enrolment, the incidence
of bacteraemia dropped significantly when HAART was widely available compared with the
period when treatment was not available (adjusted hazard ratio: 0.17; 95% CI: 0.09, 0.35). No poor
health outcomes (death or lack of clinical response to antibiotics) after bacteraemia occurred after
complete access to HAART.
conclusions HAART availability in a resource-poor setting substantially reduced the trends of bacteraemia
among HIV-infected adults. This may further impact on future morbidity and healthcare costs
of HIV-infected people.
Description
Keywords
HIV, Bacteraemia, Highly active antiretroviral therapy, Uganda
Citation
Muyanja, S. Z., Larke, N., Rutebarika, D., Kaddu, I., Nakubulwa, S., Levin, J., ... & Miiro, G. (2011). Decreasing trends of bacteraemia among HIV‐infected Ugandan adults: incidence, aetiology, clinical outcomes and effect of antiretroviral therapy in a semi‐urban setting (2000–2008). Tropical Medicine & International Health, 16(6), 756-765. doi:10.1111/j.1365-3156.2011.02754.x