15th International AIDS Conference Bangkok, Thailand - July 11-16, 2004

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1158)

Munderi P, Watera C, Nakiyingi J, Kasirye A, Walker S, French N, Gilks C, Grosskurth H
Medical Reasearch Council/ Uganda Virus Research Institute, Entebbe, Uganda

BACKGROUND: The Entebbe cohort (EC) is an active, community-based clinical cohort of HIV-infected adults set up in 1995. Recruits were staged clinically and by CD4 count at entry, followed up with standard protocols and each death confirmed. Several HIV interventions have been evaluated in this cohort before the introduction of antiretroviral therapy (ART). In January 2003, triple-drug ART was introduced when Entebbe became a site in the DART study, a randomised clinical trial evaluating strategic approaches to ART in symptomatic HIV-infected African adults. Follow up data on ART can therefore be compared with historical data in ARV naïve patients.

METHODS: The death rate observed in patients with CD4<200 cells/ul at enrolment into the EC during the first year (1995/96), is compared with the rate observed in the DART study during the first year of follow-up. Observations relate to 108.4 patient-years (PY) follow-up within the EC and 136.4 PY follow-up in DART. Patients diagnosed with malignant disease or with severe acute disease at enrolment into EC in 1995/96 are excluded from the analysis as they would not have been enrolled into the DART study.

RESULTS: See Table 1. Table 1 [table: see text]

CONCLUSIONS: The introduction of triple-drug ART has resulted in a highly statistically significant reduction in HIV related mortality among patients with advanced HIV infection in this Ugandan community. These data also show that ART initiation even in those most severely immunosupressed (CD4<50 cells/ul) is still highly beneficial.

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TuOrC1158

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