Author: Mark Mascolini
04 February 2010
Only 39% of newly diagnosed HIV-infected adults with a CD4 count below 200 cells/µL started antiretroviral therapy (ART) within 12 months of diagnosis in two South African clinics, a prospective cohort study found. Men and people without an HIV-positive friend or family member were more likely not to start therapy.
The study involved 1474 newly diagnosed adults in the South African Test, Identify and Link cohort who sought care at one of two comprehensive HIV outpatient clinics in Durban. Researchers collected data from medical records and from interviews with patients and families 12 months after HIV diagnosis.
The investigators defined eligibility to start ART as a CD4 count below 200 cells/µL. Median CD4 count at HIV diagnosis measured 159 cells/µL (interquartile range 65 to 299)
From November 2006 through October 2008, 1012 of 1474 cohort members (69%) had their CD4 count measured. Of those, 538 (53%) were eligible for ART, but only 210 ART-eligible people (39%) were known to start therapy within 12 months of HIV diagnosis.
Of the 538 ART-eligible people, 108 (20%) died during the study period. Eighty-nine of those of 108 (82%) died before ART began or with an unknown ART status.
Men were 30% more likely than women not to start ART (rate ratio 1.3, 95% confidence interval 1.1 to 1.5). People without an HIV-infected family member or friend were also 30% more likely not to start therapy (rate ratio 1.3, 95% confidence interval 1.1 to 1.7).
“Substantial attrition and mortality follow HIV diagnosis before ART initiation in Durban, South Africa,” the researchers conclude. “Major efforts directed towards earlier HIV diagnosis, effective linkage to care and timely ART initiation are urgently needed.”
Source: I.V. Bassett, S. Regan, S. Chetty, J. Giddy, L.M. Uhler, H. Holst, D. Ross, J.N. Katz, R.P. Walensky, K.A. Freedberg, E. Losina. Who starts antiretroviral therapy in Durban, South Africa? . . . not everyone who should. AIDS. 2010; 24 Suppl 1: S37-S44.
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