Untersuchungen zur Effizienz einer hochaktiven antiretroviralen Therapie bei Patienten mit HIV-Infektion / Research on the efficiency of HAART on HIV-infected persons

Introduction: The burden of disease due to HIV/AIDS and tuberculosis remains great for many countries around the world. Continuing attention must be devoted to these epidemics if we ever hope to one day contain their devastating effects on humankind. The objective of this study is to; to evaluate and compare cohort treatment outcomes of HIV infected TB patients and HIV infected non-TB patients treated with HAART at the Themba Lethu Clinic between 1st April 2004 and 1st April 2007. To measure outcomes in CD4, viral load, hemoglobin, liver function tests, weight, BMI, loss to follow up and death and to compare this outcomes between HIV patients who have had TB and HIV patients who have never had TB. Materials and Methods: information collected of patients for three years shall be used to carry out analysis. A total of 5818 patients were included in the cohort sample. 19.23% (1,048) of the patients had been diagnosed with TB at some point in time while 80.77% (4,770) had never been diagnosed with TB. Mean baseline CD4 cell counts were 113.47cells/mm3 for non TB patients and 88.85cells/mm3 for those who have ever had TB. This baseline CD4 counts are considered 2 months prior to ARV start and 1 month post the start of ARV. Baseline means for weight, BMI, AST and ALT were also taken into consideration by the two patient groups. Clinical out come was assessed and evaluated by comparing incidence of designated end points either as survival or failures. Incidence of deaths and loss to follow up was also compared in the two groups of patients. Results: Among HIV non TB patients, incidence rate of them having CD4 counts greater than 200 was at 36.47 persons per 10000 person days while for the patients who had been diagnosed with TB incidence of CD4 rising to above x 200 was lower at 34.19persons per 10000 person days. A rate ratio of 0.94 (95% CI 0.85 - 1.03) showed no true difference in the two groups. When looking at deaths in the two groups of patients, incidence in those who had TB was 3.84 deaths per 100 patient years and 4.16 deaths per 100 patient years for the non TB group with RR 0.93 and CI 0.66 - 1.28. Differences in incidence and outcomes were noticed in Hb gain, weight and BMI change, Liver function test changes over time and loss to follow up “defaulters”. Survival curves were modeled to show trend of change and log rank test were used to ascertain equality of survival curves. Where log rank p. values < 0.05 were noticed among survival curves of weight, BMI, AST, ALT, Hb and Loss to follow up. This again showed differences in weight, BMI, hemoglobin, AST, ALT and loss to follow up while no statistical differences were recognized between the two groups of patients when considering changes in CD4, deaths and Viral load over time as log rank test failed to reject the null hypothesis of similar curves. Conclusion: Data indicated that similarity and differences between HIV TB patients and HIV non TB patients could vary along certain outcomes. But one sure point is both groups of patients had an equal chance of staying alive when properly treated with ARV/HAART.

Made available in DSpace on 2014-06-12T15:51:49Z (GMT). No. of bitstreams: 2 arquivo2911_1.pdf: 1190207 bytes, checksum: 5b6e839c47604e810ad19c331924e7d8 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2010 / O uso dos antirretrovirais combinados para o tratamento de pacientes com HIV/aids inaugurou a chamada era HAART (Highly Active Antiretroviral Therapy), que proporcionou a diminuição na ocorrência de doenças oportunistas, a redução da taxa de mortalidade e o aumento significativo da expectativa de vida, além de importantes alterações no perfil nutricional desses pacientes. Em um primeiro artigo, realizou-se uma revisão da literatura publicada sobre o perfil do Índice de Massa Corporal (IMC) em pacientes com HIV/aids com o objetivo de identificar o registro de sua mudança ao longo do tempo. Evidenciou-se que a perda de peso e a desnutrição, frequentes antes do uso disseminado da HAART, apresentaram diminuição de sua prevalência após o seu uso, muito embora, em condições de baixa situação econômica, a desnutrição ainda aparece em proporções consideráveis. O uso da HAART, no entanto, provocou efeitos adversos indesejáveis, que ocasionaram o surgimento de novas características, como a lipodistrofia, dislipidemia, resistência à insulina, osteopenia, alterações glicêmicas e cardíacas e obesidade, as quais têm desafiado os profissionais de saúde envolvidos no atendimento a essa população. O segundo artigo, original, objetivou estimar a prevalência de magreza e sobrepeso/obesidade, através da aferição do IMC e fatores associados ao seu desenvolvimento em indivíduos com HIV/aids. Realizou-se, para isso, um estudo de corte seccional com caso-controle aninhado a partir de dados de 2.018 pacientes atendidos em dois hospitais de referência para doenças infecciosas em Recife-PE, no período de junho de 2007 a outubro de 2009. Todos os pacientes do estudo foram classificados como magros (IMC < 18,5 Kg/m²), sobrepesados/obesos (IMC &#8805;25 Kg/m²) e eutróficos (IMC &#8805; 18,5 24,9 Kg/m²). Realizou-se análise multinomial univariada e multivariada, considerando-se os desfechos magreza e sobrepeso/obesidade, tendo como referência os eutróficos. A prevalência de magreza foi 8,8%, e a de sobrepeso/obesidade, 32,1%. A análise multinomial multivariada revelou associação estatisticamente significante entre magreza e anemia (OR=1,78; IC (95%): 1,17 2,74; p= 0,008) e contagem de células T CD4 < 200mm³ ( OR=2,13; IC(95%): 1,41-3,24; p= 0,000). Os fatores associados ao aumento do risco de sobrepeso/obesidade foram idade &#8805; 40 anos (OR=1,30; IC (95%): 1,03-1,63; p= 0,025) e a presença de diabetes (OR=2,41; IC(95%): 1,41-4,14; p=0,001). As variáveis associadas à diminuição do risco de sobrepeso/obesidade foram: ter companheiro fixo (OR= 0,82; IC (95%): 0,73-0,92; p= 0,001), tabagismo (OR=0,58; IC(95%): 0,44-0,75; p=0,000), apresentar doença oportunista (OR= 0,67; IC(95%):0,53-0,84; p=0,001), anemia (OR=0,59; IC(95%): 0,46-0,76; p=0,000) e níveis de albumina < 3,5mg/dL (OR=0,27; IC(95%): 0,12-0,61; p=0,002). Constatou-se que, na população estudada, o principal desvio nutricional observado, avaliado pelo IMC foi, o sobrepeso/obesidade, superando a magreza. Os indivíduos mais velhos e que apresentam diabetes devem ser alvos prioritários de uma intervenção para mudanças nutricionais e de estilo de vida

Com a introdução de uma nova classe de antiretrovirais integrantes da terapia anti-retroviral altamente ativa (HAART) para o tratamento das infecções pelo vírus da imunodeficiência humana, começaram a ser descritos inúmeros efeitos secundários.Na tentativa de se estabelecer um modelo animal para o estudo destes efeitos buscou-se uma espécie com similaridade no perfil e metabolismo lipídico. Iniciou-se estudo em Mesocricetus auratus. Foram avaliados o perfil lipídico e glicêmico,função hepática e renal, níveis de auto-anticorpos anti ox-LDL, perfil eletrocardiográfico, alterações histopatológicas renais e cardíacas nos animais sob dieta hiperlipídica e normal,tratados com Indinavir, inibidor de protease utilizado na HAART. Observou-se uma diminuição da sobrevida nos animais tratados com indinavir, aumento do nível sérico de triglicérides e glicose, redução de auto-anticorpos anti ox-LDL,aumento do segmento QRS no eletrocardiograma, presença de fibrose renal e cardíaca, hipercelularidade glomerular nos animais tratados com a droga com ou sem dieta hiperlipídica quando comparados com os controles. Concluimos que Mesocricetus auratus se apresenta como um bom modelo para o desvendamento dos mecanismos patológicos observados na HAART. / With the introduction of a new antiretroviral class use, integrants of highly active anti-retroviral therapy (HAART) for the treatment of infections by human immunodeficiency virus, several side effects started to be described.To establish an animal model for the study of these side effects, was chosen specie that have similarities in the lipidic profile and metabolism. A study in Mesocricetus auratus was started. It was evaluated the lipidic and glicemic profile ,hepatic and renal function, the levels of auto-antibodies against ox-LDL, electrocardiographic profile and renal and cardiac histopathological alterations in these animals under hyperlipidic and normal diets,treated with Indinavir, a protease inhibitor used in HAART.It was observed a decrease in the survival rate in the animals treated with Indinavir; an increase of the triglycerides and glucose serum level; reduction of anti ox-LDL auto-antibodies; increased QRS segment in the electrocardiogram; presence of renal and cardiac fibrosis; glomerular hypercellularity in the animals treated with the drug, with or without hyperlipidic diet when compared with the controls. We conclude that the Mesocricetus auratus is a good model for disclosure of the pathological mechanisms generated by HAART.

Com a introdução da terapia antirretroviral altamente ativa na década de 90, assistimos ao aumento da longevidade das pessoas vivendo com HIV/AIDS que passaram a apresentar uma incidência cada vez menor de doenças oportunistas, e aumento de outros agravos à saúde relacionados ao uso prolongado da terapia e à própria longevidade. Este estudo observacional transversal buscou determinar a prevalência de comorbidades que podem afetar o manejo clínico odontológico desta população, bem como conhecer as alterações orofaciais mais prevalentes nos pacientes HIV positivos atendidos no Centro de Atendimento a Pacientes Especiais da FOUSP. Adicionalmente, comparamos os dados obtidos nesse estudo, com estudo semelhante desenvolvido no mesmo centro, há uma década, e também avaliamos o impacto da condição bucal na qualidade de vida destes indivíduos. Foram incluídos 101 pacientes HIV positivos, examinados sempre pela mesma pesquisadora. Todos estavam sob HAART. Foram aplicados questionários aos participantes a respeito da história médica e odontológica pregressa e atual, aplicação do OHIP-14 e avaliação de exames hematológicos. Em todos os participantes foi realizado exame orofacial em cadeira odontológica, índice CPOD e ICP, e em 95 deles também a quantificação do fluxo salivar estimulado. Do total, 42,5% apresentaram ao menos uma manifestação orofacial, sendo a lipoatrofia facial de maior incidência (32,7%), seguida pela xerostomia (29,7%), aumento de glândulas salivares (11,9%) e aumento de linfonodos cervicais (4,9%). Ao menos uma comorbidade, excluindo-se alergia para a contagem, acometeu 88,1% (89/101) dos participantes e as mais prevalentes foram lipodistrofia (49,5%) e desordens psiquiátricas (37,6%). As alterações do hemograma foram observadas em 7,3% dos participantes para leucócitos, 4,9% neutrófilos e 10,9% em hemoglobina, sendo os valores críticos raramente evidenciados. Foi verificado impacto negativo moderado quanto à autopercepção de qualidade de vida relacionada à condição oral. A comparação com os dados obtidos há uma década revelaram aumento na incidência de lipodistrofia e distúrbios psiquiátricos como depressão e ansiedade. A incidência de manifestações bucais manteve-se semelhante, à exceção de xerostomia, que apresentou aumento, e a pigmentação da mucosa bucal, que apresentou diminuição nestes dez anos. Além disso, a média obtida entre os valores de CD4 foi significativamente maior no presente estudo, assim como a média etária dos pacientes (p<0,05). Concluímos que, de modo geral, as alterações sistêmicas encontradas não limitaram o atendimento odontológico ambulatorial, e que embora raras, as alterações hematológicas encontradas demonstram a importância da solicitação do hemograma previamente ao tratamento. O dentista deve estar atento às manifestações orofaciais, principalmente as oportunistas, que podem denunciar falta de adesão ou falha da TARV. Foi evidenciado um impacto negativo moderado quanto à qualidade de vida relacionada à condição bucal, que deve ser investigado em estudos futuros. Decorrida uma década, nota-se maior longevidade dos pacientes, associada à qualidade de vida, que pode ser demonstrada através da maior média de linfócitos T CD4 encontrada. / With the introduction of highly active antiretroviral therapy in the 1990s, we have seen an increase in the longevity of people living with HIV/AIDS, which has had a decreasing incidence of opportunistic diseases and an increase in other health problems related to long-term use of HIV. therapy and longevity itself. This cross-sectional observational study aimed to determine the prevalence of comorbidities that may affect the dental management of this population, as well as to know the most prevalent orofacial alterations in HIV positive patients seen at the FOUSP Special Patient Care Center. In addition, we compared the data obtained in this study, with a similar study developed in the same center a decade ago, and also evaluated the impact of the oral condition on the quality of life of these individuals. We included 101 HIV positive patients, always examined by the same researcher. Everyone was under HAART. Questionnaires were applied to participants regarding previous and current medical and dental history, OHIP-14 application, and evaluation of hematological exams. In all the participants, dental examinations were carried out in a dental chair, CPOD index and PCI, and in 95 of them the quantification of stimulated salivary flow. From the total, 42.5% had at least one orofacial manifestation, with facial lipoatrophy with a higher incidence (32.7%), followed by xerostomia (29.7%), salivary glands (11.9%) and increased of cervical lymph nodes (4.9%). At least one comorbidity, excluding allergy for counting, affected 88.1% (89/101) of the participants and the most prevalent were lipodystrophy (49.5%) and psychiatric disorders (37.6%). Changes in blood counts were observed in 7.3% of the participants for leukocytes, 4.9% neutrophils and 10.9% in hemoglobin, and the critical values were rarely evidenced. Moderate negative impact on self - perceived quality of life related to the oral condition was verified. The comparison with data obtained a decade ago revealed an increase in the incidence of lipodystrophy and psychiatric disorders such as depression and anxiety. The incidence of oral manifestations remained similar, with the exception of xerostomia, which presented an increase, and the pigmentation of the buccal mucosa, which presented a decrease in these ten years. In addition, the average value obtained between CD4 values was significantly higher in the present study, as was the average age of the patients (p<0.05). We concluded that, in general, the systemic alterations found did not limit outpatient dental care, and although rare, the hematological alterations found demonstrate the importance of requesting the blood count prior to treatment. The dentist should be aware of orofacial manifestations, especially opportunists, who may report lack of compliance or failure of ART. A moderate negative impact on the quality of life related to the oral condition was evidenced, which should be investigated in future studies. After a decade, there is a greater longevity of the patients, associated to the quality of life, which can be demonstrated through the higher CD4 T lymphocyte count found.

Com a introdução da terapia antirretroviral altamente ativa na década de 90, assistimos ao aumento da longevidade das pessoas vivendo com HIV/AIDS que passaram a apresentar uma incidência cada vez menor de doenças oportunistas, e aumento de outros agravos à saúde relacionados ao uso prolongado da terapia e à própria longevidade. Este estudo observacional transversal buscou determinar a prevalência de comorbidades que podem afetar o manejo clínico odontológico desta população, bem como conhecer as alterações orofaciais mais prevalentes nos pacientes HIV positivos atendidos no Centro de Atendimento a Pacientes Especiais da FOUSP. Adicionalmente, comparamos os dados obtidos nesse estudo, com estudo semelhante desenvolvido no mesmo centro, há uma década, e também avaliamos o impacto da condição bucal na qualidade de vida destes indivíduos. Foram incluídos 101 pacientes HIV positivos, examinados sempre pela mesma pesquisadora. Todos estavam sob HAART. Foram aplicados questionários aos participantes a respeito da história médica e odontológica pregressa e atual, aplicação do OHIP-14 e avaliação de exames hematológicos. Em todos os participantes foi realizado exame orofacial em cadeira odontológica, índice CPOD e ICP, e em 95 deles também a quantificação do fluxo salivar estimulado. Do total, 42,5% apresentaram ao menos uma manifestação orofacial, sendo a lipoatrofia facial de maior incidência (32,7%), seguida pela xerostomia (29,7%), aumento de glândulas salivares (11,9%) e aumento de linfonodos cervicais (4,9%). Ao menos uma comorbidade, excluindo-se alergia para a contagem, acometeu 88,1% (89/101) dos participantes e as mais prevalentes foram lipodistrofia (49,5%) e desordens psiquiátricas (37,6%). As alterações do hemograma foram observadas em 7,3% dos participantes para leucócitos, 4,9% neutrófilos e 10,9% em hemoglobina, sendo os valores críticos raramente evidenciados. Foi verificado impacto negativo moderado quanto à autopercepção de qualidade de vida relacionada à condição oral. A comparação com os dados obtidos há uma década revelaram aumento na incidência de lipodistrofia e distúrbios psiquiátricos como depressão e ansiedade. A incidência de manifestações bucais manteve-se semelhante, à exceção de xerostomia, que apresentou aumento, e a pigmentação da mucosa bucal, que apresentou diminuição nestes dez anos. Além disso, a média obtida entre os valores de CD4 foi significativamente maior no presente estudo, assim como a média etária dos pacientes (p<0,05). Concluímos que, de modo geral, as alterações sistêmicas encontradas não limitaram o atendimento odontológico ambulatorial, e que embora raras, as alterações hematológicas encontradas demonstram a importância da solicitação do hemograma previamente ao tratamento. O dentista deve estar atento às manifestações orofaciais, principalmente as oportunistas, que podem denunciar falta de adesão ou falha da TARV. Foi evidenciado um impacto negativo moderado quanto à qualidade de vida relacionada à condição bucal, que deve ser investigado em estudos futuros. Decorrida uma década, nota-se maior longevidade dos pacientes, associada à qualidade de vida, que pode ser demonstrada através da maior média de linfócitos T CD4 encontrada. / With the introduction of highly active antiretroviral therapy in the 1990s, we have seen an increase in the longevity of people living with HIV/AIDS, which has had a decreasing incidence of opportunistic diseases and an increase in other health problems related to long-term use of HIV. therapy and longevity itself. This cross-sectional observational study aimed to determine the prevalence of comorbidities that may affect the dental management of this population, as well as to know the most prevalent orofacial alterations in HIV positive patients seen at the FOUSP Special Patient Care Center. In addition, we compared the data obtained in this study, with a similar study developed in the same center a decade ago, and also evaluated the impact of the oral condition on the quality of life of these individuals. We included 101 HIV positive patients, always examined by the same researcher. Everyone was under HAART. Questionnaires were applied to participants regarding previous and current medical and dental history, OHIP-14 application, and evaluation of hematological exams. In all the participants, dental examinations were carried out in a dental chair, CPOD index and PCI, and in 95 of them the quantification of stimulated salivary flow. From the total, 42.5% had at least one orofacial manifestation, with facial lipoatrophy with a higher incidence (32.7%), followed by xerostomia (29.7%), salivary glands (11.9%) and increased of cervical lymph nodes (4.9%). At least one comorbidity, excluding allergy for counting, affected 88.1% (89/101) of the participants and the most prevalent were lipodystrophy (49.5%) and psychiatric disorders (37.6%). Changes in blood counts were observed in 7.3% of the participants for leukocytes, 4.9% neutrophils and 10.9% in hemoglobin, and the critical values were rarely evidenced. Moderate negative impact on self - perceived quality of life related to the oral condition was verified. The comparison with data obtained a decade ago revealed an increase in the incidence of lipodystrophy and psychiatric disorders such as depression and anxiety. The incidence of oral manifestations remained similar, with the exception of xerostomia, which presented an increase, and the pigmentation of the buccal mucosa, which presented a decrease in these ten years. In addition, the average value obtained between CD4 values was significantly higher in the present study, as was the average age of the patients (p<0.05). We concluded that, in general, the systemic alterations found did not limit outpatient dental care, and although rare, the hematological alterations found demonstrate the importance of requesting the blood count prior to treatment. The dentist should be aware of orofacial manifestations, especially opportunists, who may report lack of compliance or failure of ART. A moderate negative impact on the quality of life related to the oral condition was evidenced, which should be investigated in future studies. After a decade, there is a greater longevity of the patients, associated to the quality of life, which can be demonstrated through the higher CD4 T lymphocyte count found.

Com a introdução de uma nova classe de antiretrovirais integrantes da terapia anti-retroviral altamente ativa (HAART) para o tratamento das infecções pelo vírus da imunodeficiência humana, começaram a ser descritos inúmeros efeitos secundários.Na tentativa de se estabelecer um modelo animal para o estudo destes efeitos buscou-se uma espécie com similaridade no perfil e metabolismo lipídico. Iniciou-se estudo em Mesocricetus auratus. Foram avaliados o perfil lipídico e glicêmico,função hepática e renal, níveis de auto-anticorpos anti ox-LDL, perfil eletrocardiográfico, alterações histopatológicas renais e cardíacas nos animais sob dieta hiperlipídica e normal,tratados com Indinavir, inibidor de protease utilizado na HAART. Observou-se uma diminuição da sobrevida nos animais tratados com indinavir, aumento do nível sérico de triglicérides e glicose, redução de auto-anticorpos anti ox-LDL,aumento do segmento QRS no eletrocardiograma, presença de fibrose renal e cardíaca, hipercelularidade glomerular nos animais tratados com a droga com ou sem dieta hiperlipídica quando comparados com os controles. Concluimos que Mesocricetus auratus se apresenta como um bom modelo para o desvendamento dos mecanismos patológicos observados na HAART. / With the introduction of a new antiretroviral class use, integrants of highly active anti-retroviral therapy (HAART) for the treatment of infections by human immunodeficiency virus, several side effects started to be described.To establish an animal model for the study of these side effects, was chosen specie that have similarities in the lipidic profile and metabolism. A study in Mesocricetus auratus was started. It was evaluated the lipidic and glicemic profile ,hepatic and renal function, the levels of auto-antibodies against ox-LDL, electrocardiographic profile and renal and cardiac histopathological alterations in these animals under hyperlipidic and normal diets,treated with Indinavir, a protease inhibitor used in HAART.It was observed a decrease in the survival rate in the animals treated with Indinavir; an increase of the triglycerides and glucose serum level; reduction of anti ox-LDL auto-antibodies; increased QRS segment in the electrocardiogram; presence of renal and cardiac fibrosis; glomerular hypercellularity in the animals treated with the drug, with or without hyperlipidic diet when compared with the controls. We conclude that the Mesocricetus auratus is a good model for disclosure of the pathological mechanisms generated by HAART.

ABSTRACT Introduction South Africa is estimated to have the largest number of HIV infected adults in Southern Africa with a higher HIV prevalence in females compared to males. While significant reductions in morbidity and mortality due to HIV and AIDS have been realized for over a decade internationally, HIV treatment involving highly active antiretroviral therapy (HAART) is still a relatively new phenomenon in this country and gender differences in HIV outcomes between males and females in South Africa have not been previously well described. This study aimed to determine and describe gender differences in clinical and immunological outcomes in a population of HIV infected South African adults initiated on HAART. Materials and Methods This retrospective data analysis reviewed 6,617 HIV-infected adultsABSTRACT Introduction South Africa is estimated to have the largest number of HIV infected adults in Southern Africa with a higher HIV prevalence in females compared to males. While significant reductions in morbidity and mortality due to HIV and AIDS have been realized for over a decade internationally, HIV treatment involving highly active antiretroviral therapy (HAART) is still a relatively new phenomenon in this country and gender differences in HIV outcomes between males and females in South Africa have not been previously well described. This study aimed to determine and describe gender differences in clinical and immunological outcomes in a population of HIV infected South African adults initiated on HAART. Materials and Methods This retrospective data analysis reviewed 6,617 HIV-infected adults initiated on HAART at the Themba Lethu Clinic, an urban public-sector antiretroviral rollout facility in Johannesburg, South Africa between 1st April 2004 and 31st March 2007. Clinical data from these antiretroviral naïve patients was analysed for gender differences in mortality, rates of loss to follow up, CD4 cell count response, virologic suppression and weight gain. Cox regression models and logistic regression models were used to estimate hazard ratios (HR) and odds ratios (OR), respectively, for associations between gender and outcomes. Models were adjusted for age and baseline CD4 count. Results At baseline, 4,388 (66.3%) women were significantly younger (p<0.0001) and less likely to be employed than the 2,229 (33.7%) men (p<0.001). Furthermore, women had significantly higher baseline CD4 counts (p<0.0001) and higher body mass index (BMI) (p<0.0001). Males experienced significantly reduced survival compared to females (p=0.0053) by Kaplan-Meier analysis. In adjusted multivariate analysis, men were 22% more likely to die or become lost to follow up than women [HR = 1.22 (95% CI 1.06 - 1.39]. The period with the highest risk of mortality or loss to follow up was within six months of starting HAART. Female gender was associated with better CD4 count response. In multivariate analysis adjusted for age and baseline CD4 count, women were 35% more likely to achieve a 100 cell increase in CD4 count at four months after initiation of HAART [OR =1.35 (95% CI = 1.19 -1.54)] and 45% more likely to increase their CD4 counts by 100 cells/mm3 after ten months on HAART [OR =1.42 (95% CI = 1.20 -1.68)] when compared to men. Women were also more likely to achieve virologic suppression at ten months post HAART initiation [OR =1.54 (95% CI =1.21-1.97)] and were more likely to have gained weight after four months on treatment than males [OR = 1.26 (95% CI = 1.07–1.49)] after adjusting for age, baseline CD4 count and baseline BMI. Conclusions Women had significant advantages over men in terms of short-term clinical and immunological outcomes. Earlier access treatment for men should be facilitated and adherence should be promoted once on treatment. Further research is required to determine if these gender differences persist during long-term HAART.

Background Adherence to HAART is key to any successful HAART programme. In Madzikane KaZulu Memorial Hospital ARV Clinic, there is an increasing number of patients on HAART and an increasing number of patients still awaiting HAART initiation. With the paucity of healthcare personnel in this rural district hospital, suboptimal patient’s preparation for HAART often occurs, and the HAART defaulter rate is on the increase. This is may be attributed to an interplay of factors affecting HAART adherence. Aim and Objectives The aim of this research was to determine the prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the Madzikane KaZulu Memorial Hospital (MKMH) ARV clinic. The objectives were: • To conduct an audit on all case files of patients on HAART over the study period. • To explore the behavioural aspects of poor HAART adherence in a focused group discussion. • To describe the factors associated with good HAART adherence Methods Study design: A cross-sectional descriptive study which focused on determining the prevalence of established factors( patient-related, therapy-related and facility-related factors) affecting HAART adherence at the ARV clinic was carried out among identified HAART non-adhering patients. Patients that were not adhering with HAART between the period of January 2009 and December 2010 were selected for the study. These patients were 19 years or more and had been on HAART for at least two months. The study was carried out between November and December 2010. The result of the focused group discussion was utilized to refine the development of the questionnaire. Setting: The study was conducted at the Madzikane KaZulu Memorial Hospital ARV clinic. This is a modern 269 bed district hospital in the Mount Frere, Alfred Nzo district, Eastern Cape Province of South Africa. This is a predominantly rural region. Results: Data for analysis was provided by 215 patients that fulfilled the inclusion criteria. The prevalence rate of the factors affecting HAART adherence at the hospitals ARV clinic was 24%. A total of 60% of the patients were females. Majority of the patients (86.1%) had treatment supporters, and more than half of the patients (57.2%) were unemployed and not on disability grant. A total of 62.8% of the patients prefer to take their ARV at a clinic near them, and the majority of these patients (96.3%) want to start taking their ARV in a nearby clinic within 6months. The female gender, unemployment not on disability grant, longer period on HAART, Regimen 1A ARV( stavudine or tenofovir plus lamivudine and efavirenz according to the National ART guideline 2004 and its modified version of April 2010) single marital status and probably poorly selected unprepared treatment supporters, are associated with poor HAART adherence at this ARV clinic. Conclusion The study revealed that the prevalence rate of the factors affecting HAART adherence at the Madzikane KaZulu Hospital ARV clinic was 24% amongst HAART non-adhering patients. These patients had the prevalence rate of patient-related factors (12.4%) more than double of the prevalence rates of therapy related factors (5.8%), and facility related factors (5.7%). Topmost amongst the associated factors for not adhering to HAART were: not belonging to a support group, the pills making the patient feel unwell, and the ARV clinic being too far from where the patients live. Efforts should be targeted at enrolling the patients in support groups, encouraging the use of HAART regimens that have good tolerability profiles, and establishing the down referral.

No description available.