Author: Mark Mascolini
06 February 2010
People in Cameroon not taking antiretroviral therapy (ART) had low quality-of-life scores, used condoms infrequently, and disclosed their HIV status less frequently than treated people, according to results of a national cross-sectional survey.
At the time of the survey, Cameroon’s decentralized HIV care program followed then-current World Health Organization guidelines for starting ART when the CD4 count fell below 200 cells/µL or when an AIDS disease developed. EVAL (ANRS 12-116) investigators began this study to see how starting ART according to those guidelines affected psychosocial and clinical findings in adults.
The survey involved 3151 people attending HIV services from September 2006 to March 2007. The investigators used generalized linear models to assess the impact of not receiving ART on health-related quality of life, inconsistent condom use with sexual partners of unknown or discordant HIV status, self-reported symptoms, and disclosure of HIV status.
Most study participants—78%—were taking ART. Of the 22% who were not, 8% had a CD4 count below 200 cells/µL or an AIDS diagnosis, 5% had a CD4 count between 200 and 350 cells/µL, and 8% had a CD4 count above 350 cells/µL.
Multivariate analysis showed that, regardless of CD4 count, four factors were significantly associated with not starting ART: impaired physical quality of life, more frequent inconsistent condom use, more self-reported symptoms, and less frequent HIV status disclosure (P < 0.0001 for all).
“In addition to increasing clinical effectiveness,” the EVAL investigators conclude, “earlier initiation of ART at less severe immune-depression levels than previously recommended by World Health Organization guidelines for low-resource settings may be justified for improving subjective health and positive prevention among people living with HIV.”
The World Health Organization now recommends starting ART when the CD4 count falls to 350 cells/µL or less, regardless of symptoms.
Source: F. Marcellin, C.R. Bonono, J. Blanche, M.P. Carrieri, B. Spire, S. Koulla-Shiro, EVAL Study Group. Higher risk of unsafe sex and impaired quality of life among patients not receiving antiretroviral therapy in Cameroon: results from the EVAL survey (ANRS 12-116). AIDS. 2010; 24 Suppl 1; S17-S25.
For the study abstract
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For the WHO guidelines