Initiation of antiretroviral therapy based on the 2015 WHO guidelines.
Kuznik A; Iliyasu G; Habib AG; Musa BM; Kambugu A; Lamorde M
AIDS. 2016 Nov 28; 30(18):2865-2873.
OBJECTIVE: In 2015, the WHO recommended initiation of antiretroviral therapy (ART) in all HIV-positive patients regardless of CD4 cell count. We evaluated the cost-effectiveness of immediate versus deferred ART initiation among patients with CD4 cell counts exceeding 500cells/mul in four resource-limited countries (South Africa, Nigeria, Uganda, and India). DESIGN: A 5-year Markov model with annual cycles, including patients at CD4 cell counts more than 500 cells/mul initiating ART or deferring therapy until historic ART initiation criteria of CD4 cell counts more than 350 cells/mul were met. METHODS: The incidence of opportunistic infections, malignancies, cardiovascular disease, unscheduled hospitalizations, and death, were informed by the START trial results. Risk of HIV transmission was obtained from a systematic review. Disability weights were based on published literature. Cost inputs were inflated to 2014 US dollars and based on local sources. Results were expressed in cost per disability-adjusted life years averted and measured against WHO cost-effectiveness thresholds. RESULTS: Immediate initiation of ART is associated with a cost per disability-adjusted life years averted of -$317 [95% confidence interval (CI): -$796-$817] in South Africa; -$507 (95% CI: -$765-$837) in Nigeria; -$136 (-$382-$459) in Uganda; and -$78 (-$256-$374) in India. The results are largely driven by the impact of ART on reducing the risk of new HIV transmissions. CONCLUSIONS: In HIV-positive patients with CD4 counts above 500 cells/mul in the four studied countries, immediate initiation of ART versus deferred therapy until historic eligibility criteria are met is cost-effective and likely even cost-saving over time.
Prevalence of Malnutrition and Associated Factors among Hospitalized Patients with Acquired Immunodeficiency Syndrome in Jimma University Specialized Hospital, Ethiopia.
Mulu H; Hamza L; Alemseged F
Ethiopian Journal of Health Sciences. 2016 May; 26(3):217-26.
BACKGROUND: HIV/AIDS predisposes to malnutrition. Malnutrition exacerbates HIV/AIDS progression resulting in increased morbidity and mortality. The magnitude of malnutrition in HIV/AIDS patients has not been well studied in Ethiopian setup. Our objective was to assess the prevalence of malnutrition and associated factors among HIV/AIDS patients admitted to Jimma University Specialized Hospital (JUSH). METHOD: A cross-sectional study was conducted to assess the nutritional status of 109 HIV/AIDS patients admitted from November 2013 to July 2014. Cohort design was also used for outcome assessment. Serum levels of hemoglobin, albumin and CD4 counts were determined. Data were organized, coded, cleaned, entered into a computer and analyzed using SPSS version 16.0. Descriptive analysis was done initially. Those variables in the bivariate analysis with P-value < 0.25 were then considered as candidates to be included in the multivariable logistic regression model. A P-vale of < 0.05 was considered as statistically significant. RESULTS: The mean age of the patients was 32.7+/-8.12 with male to female ratio of 1:1.9. Patients were in either clinical stage, 3(46.8%), or stage, 4(53.2%). Forty nine (45%) of the respondents had a CD4 count of < 200 cells/microL. The overall prevalence of malnutrition was 46.8% (BMI<18.5kg/m2) and 44.1% (MUAC<12g/dl). CONCLUSION: The prevalence of malnutrition was found to be high. WHO Stage 4 disease and CD4 count <200cells/microl were independent predictors of malnutrition.
WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts.
Teck R; Ascurra O; Gomani P; Manzi M; Pasulani O
International Journal of Tuberculosis and Lung Disease. 2005 Mar; 9(3):258-262.
Setting: Thyolo district, Malawi. Objectives: To determine in HIV- positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). Design: Cross-sectional study. Methods: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. Results: A CD4 lymphocyte count of =350 cells/µl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. Conclusions: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of =350 cells/µl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy. (author's)
Drug resistant tuberculosis soars in eastern Europe.
Odigwe C
BMJ. British Medical Journal. 2004; 328:[3] p..
Multidrug resistant tuberculosis in parts of eastern Europe and the former Soviet Union is 10 times as common as in most parts of the world, a new report from the World Health Organization said this week. The report, which is WHO's third on drug resistant tuberculosis, contains new data obtained from the WHO/IUATLD (International Union Against Tuberculosis and Lung Disease) Global Project on Anti- Tuberculosis Drug Resistance Surveillance. Speaking at the report's launch in London this week, Dr Paul Nunn, coordinator of tuberculosis, HIV, and drug resistance at the Stop TB department of WHO, said: "We see about nine million cases worldwide every year and about two million deaths." He said: "This report . . . covers 77 geographic settings, most of which are countries—except in certain instances like China, where several settings are in one country. Thirty nine of the settings are new, and 67 657 cases were tested. (excerpt)
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