International Journal of STD & AIDS > Volume 17, Number 2 > Pp. 116-120

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Original research articles

Clinical illness as a marker for initiation of HIV antiretroviral therapy in a rural setting, Rakai, Uganda

Lisa A Spacek, Ronald H Gray, Maria J Wawer, Nelson K Sewankambo, David Serwadda, Fred Wabwire-Mangen, Noah Kiwanuka, Godfrey Kigozi, Fred Nalugoda, Thomas C Quinn and Rakai Project Study Group

Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Heilbrun Center for Population and Family Health, Columbia University, Joseph L Mailman School of Public Health, NY, USA; Department of Medicine and Faculty of Medicine, Makerere University, Kampala, Uganda; Institute of Public Health, Makerere University, Kampala, Uganda; Institute of Public Health, Makerere University, Kampala, Uganda; Rakai Project, Uganda Virus Research Institute, Entebbe, Uganda; Rakai Project, Uganda Virus Research Institute, Entebbe, Uganda; Rakai Project, Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

The aim of this study is to assess whether HIV-related illness and World Health Organization (WHO) clinical stage can be used to guide initiation of antiretroviral therapy (ART) in rural Rakai District, Uganda. A retrospective cohort analysis of 910 HIV-seroprevalent individuals randomly sampled from a community cohort was conducted.

The associations between HIV-related clinical illness and HIV viral loads >55,000 copies/mL and death were evaluated as a guide for initiation of ART. Reporting one or more HIV-related illnesses was associated with high specificity for identifying HIV viral load >55,000 copies/mL and predicting death within 30 months. There were more deaths in those with one symptom at baseline (16.3%) and two or more symptoms (25.0%) than in those reporting no symptoms (9.6%; P = 0.001).

HIV-related illness and WHO stage predicted disease progression. The specificity of clinical illness to predict viral load >55,000 copies/mL was high and could be used to rule in HIV disease requiring ART.

Key Words: AIDS CARE • RESOURCE-LIMITED SETTING • ANTIRETROVIRAL THERAPY • ALGORITHMS • UGANDA

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