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Observational Study
. 2023 Oct 11;18(10):e0292660.
doi: 10.1371/journal.pone.0292660. eCollection 2023.

Rapid antiretroviral therapy initiation in patients with advanced HIV disease: 6-month outcomes of an observational cohort evaluation in Lesotho

Appolinaire Tiam  1 , Heather Paulin  2 , Rhoderick Machekano  1 , Ikwo Oboho  2 , Elfriede Agyemang  2 , Fred Asiimwe Mugyenyi  3 , Llang Maama-Maime  4 , Yohannes Mengistu  3 , Tsitsi Chatora  5 , More Mungati  5 , Majoalane Mokone  5 , Tsietso Mots'oane  4 , Annah Masheane  4 , Vincent Tukei  5
Affiliations
Observational Study

Rapid antiretroviral therapy initiation in patients with advanced HIV disease: 6-month outcomes of an observational cohort evaluation in Lesotho

Appolinaire Tiam et al. PLoS One. .

Abstract

For adults and adolescents, the World Health Organization defines advanced HIV disease (AHD) as a CD4 (cluster of differentiation 4) count of <200 cells/mm3 or a clinical stage 3 or 4 event. We describe clinical outcomes in a cohort of AHD patients at two regional hospitals in Lesotho. From November 2018-June 2019, we prospectively enrolled eligible patients (≥15 years) not on antiretroviral therapy (ART) presenting with WHO-defined AHD into a differentiated model of care for AHD (including rapid ART initiation) and followed them for six months. All patients received Tuberculosis (TB) symptom screening with further diagnostic testing; serum cryptococcal antigen (CrAg) screening was done for CD4 <100 cells/mm3 or WHO clinical stage 3 or 4. Medical record data were abstracted using visit checklist forms. Categorical and continuous variables were summarized using frequencies, percentages, and means, respectively. Kaplan-Meier was used to estimate survival. Of 537 HIV-positive patients screened, 150 (27.9%) had AHD of which 109 were enrolled. Mean age was 38 years and 62 (56.9%) were men. At initial clinic visit, 8 (7.3%) were already on treatment and 33% (36/109) had presumptive TB per symptom screening. Among 39/109 (40.2%) patients screened for CrAg at initial visit, five (12.8%) were CrAg-positive. Among 109 enrolled, 77 (70.6%) initiated ART at their initial clinic visit, while 32 delayed ART initiation (median delay: 14 days). Of the 109 participants enrolled, 76 (69.7%) completed the 6-month follow-up, 17 (15.6%) were lost to follow-up, 5 (4.6%) transferred to other health facilities and 11 (10.1%) died. The 6-month survival was 87.4%; among 74 patients with a viral load result, 6-month viral suppression (<1,000 copies/ml) was 85.1%. Our study found that even after the implementation of Test and Treat of ART in 2016 in Lesotho, over 25% of patients screened had AHD. Patients with AHD had a high prevalence of TB and CrAg positivity, underscoring the need to assess for AHD and rapidly initiate ART within a package of AHD care for optimal patient outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. TB screening, diagnosis, prevention and treatment cascade.
This figure captures the TB cascade among study participants. This includes symptom-based screening, diagnosis including laboratory, initiation on TB preventive therapy and the treatment initiation and outcomes.
Fig 2
Fig 2. Screening and enrollment of participants.
This figure describes the identification of patients with AHD and their enrollment into the study.
Fig 3
Fig 3. Estimated 6-month survival among patients with Advanced HIV Disease (n = 109).
Fig 3 captures the survival analysis over a six-month period from the time of enrollment in the study.
See this image and copyright information in PMC

References

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