Evaluation of patients' response to treatment with highly active antiretroviral therapy at the Infectious Diseases Institute, Kampala.

Abstract

BACKGROUND: In Africa, a consideration number of clients get diagnosed with HIV for the first time after a WHO stage 4 illness. Evidence in the developed world shows that individuals who initiate ART with advanced HIV/AIDS may not have as good responses as those with early HIV disease. Data on this important subject in Africa is limited. OBJECTIVE: Compare clinical and immunological treatment outcomes in individuals with WHO stage 4 versus stage 2 and 3 disease. METHODS: 496 adults HIV infected ART naïve patients were evaluated. Clinical and immunological parameters were analysed at baseline, six and 12 months of HAART. RESULTS: HARRT initiation resulted in rise in absolute CD4 counts and improvement of clinical parameters. Responses were better for WHO stage 2 and 3 than stage 4. After 6 months of HAART initiation, there was a statistically significant difference in the livelihood of being diagnosed with OLs between the two groups (RR=0.09, 95%C1=0.012-0.690). At 6 months after HAART initiation, the difference in the mean karnofsky score between the two categories of patients was statistically significant with a mean difference of 3% (95% C1=0.476, 3.62). At 12 months, the difference in the mean karnofsky score between the two categories of patients was statistically significant with a mean difference of 4.0% (95% C1=0.602 to 5.00) CONCLUSION: Better clinical and immunological treatment responses were noted in WHO stage 2 and 3 compared to stage 4 and at 12 months of HAART compared to 6 months. Individuals initiating ART with advanced disease in Africa do not show good clinical and immunological responses compared to those with early symptomatic disease.