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

• Published in: Tropical medicine & international health 2009-05, Vol.14 (5), p.556-563
• Main Authors: Miiro, George, Todd, Jim, Mpendo, Juliet, Watera, Christine, Munderi, Paula, Nakubulwa, Susan, Kaddu, Ismael, Rutebarika, Diana, Grosskurth, Heiner
• Format: Article
• Language: English
• Subjects: Adult; adverse events; Aged; Anti-Infective Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; cotrimoxazole prophylaxis; Drug therapy; eventos adversos; Female; General aspects; HAART; highly active anti-retroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - mortality; HIV-1; Human immunodeficiency virus; Humans; Male; Medical sciences; Middle Aged; Morbidity; morbidité; morbilidad; Mortality; Pharmacology. Drug treatments; Practice Guidelines as Topic; profilaxis con cotrimoxazol; prophylaxie au cotrimoxazole; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Uganda - epidemiology; Young Adult; événements indésirables
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2009.02259.x

To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility. 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. 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/μl) 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/μl) 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). These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis.