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. 2012:2012:814564.
doi: 10.1155/2012/814564. Epub 2012 May 29.

Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya

April J Bell  1 , Kara Wools-Kaloustian, Sylvester Kimaiyo, Hai Liu, Adrian Katschke, Changyu Shen, Gilbert Simiyu, Beverly S Musick, John E Sidle, Abraham Siika, Paula Braitstein
Affiliations

Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya

April J Bell et al. AIDS Res Treat. 2012.

Abstract

Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya. Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders. Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P < 0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06-1.39) and LTFU (HR = 1.12; 95% CI : 1.04-1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR = 0.92 95% CI 0.82-1.03). Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

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Figure 1
Figure 1
Kaplan-Meier estimates of cumulative survival function of time to (a) new AIDS defining event (ADE); (b) death; (c) loss to follow-up.
See this image and copyright information in PMC

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