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Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya.

Bell AJ, Wools-Kaloustian K, Kimaiyo S, Liu H, Katschke A, Shen C, Simiyu G, Musick BS, Sidle JE, Siika A, Braitstein P - AIDS Res Treat (2012)

Bottom Line: Cox models were used to adjust for potential confounders.After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06-1.39) and LTFU (HR = 1.12; 95% CI : 1.04-1.22).Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

View Article: PubMed Central - PubMed

Affiliation: Indiana University School of Medicine, 1001 West 10th Street, OPW M200, Indianapolis, IN 46202, USA.

ABSTRACT
Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya. Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders. Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P < 0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06-1.39) and LTFU (HR = 1.12; 95% CI : 1.04-1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR = 0.92 95% CI 0.82-1.03). Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimates of cumulative survival function of time to (a) new AIDS defining event (ADE); (b) death; (c) loss to follow-up.
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fig1: Kaplan-Meier estimates of cumulative survival function of time to (a) new AIDS defining event (ADE); (b) death; (c) loss to follow-up.

Mentions: There were 1,358 new AIDS defining events during the follow-up period including 573 among the cap group and 785 among the pre-cap group. After adjustment for potential confounders, there was no effect of the cap on the risk of developing a new WHO Stage III or IV illness (HR: 0.92; 95% CI: 0.82, 1.03) (Figure 1(a), Table 3).


Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya.

Bell AJ, Wools-Kaloustian K, Kimaiyo S, Liu H, Katschke A, Shen C, Simiyu G, Musick BS, Sidle JE, Siika A, Braitstein P - AIDS Res Treat (2012)

Kaplan-Meier estimates of cumulative survival function of time to (a) new AIDS defining event (ADE); (b) death; (c) loss to follow-up.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368312&req=5

fig1: Kaplan-Meier estimates of cumulative survival function of time to (a) new AIDS defining event (ADE); (b) death; (c) loss to follow-up.
Mentions: There were 1,358 new AIDS defining events during the follow-up period including 573 among the cap group and 785 among the pre-cap group. After adjustment for potential confounders, there was no effect of the cap on the risk of developing a new WHO Stage III or IV illness (HR: 0.92; 95% CI: 0.82, 1.03) (Figure 1(a), Table 3).

Bottom Line: Cox models were used to adjust for potential confounders.After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06-1.39) and LTFU (HR = 1.12; 95% CI : 1.04-1.22).Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

View Article: PubMed Central - PubMed

Affiliation: Indiana University School of Medicine, 1001 West 10th Street, OPW M200, Indianapolis, IN 46202, USA.

ABSTRACT
Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya. Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders. Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P < 0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06-1.39) and LTFU (HR = 1.12; 95% CI : 1.04-1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR = 0.92 95% CI 0.82-1.03). Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

No MeSH data available.


Related in: MedlinePlus