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HIV Mortality In Poor-Resource Countries Reduced By Antiretroviral Program
A recent article in the journal The Lancet
reports that in poor countries, mortality and orphanhood associated
with HIV can be reduced through a home-based antiretroviral treatment
(ART) program. Dr Jonathan Mermin, Centers for Disease Control
and
Prevention, Nairobi, Kenya, and colleagues also recommend that the ART
program be implemented throughout the rest of the world.
Currently,
the most effective way to clinically treat patients with HIV and reduce
mortality is ART. Ninety percent of HIV-infected people live in
developing countries, and 63% live in Africa. ART is becoming more
available to these people, but it is still not reaching many of the
people in Africa who need it. Barriers such as high medication costs,
few trained health-care providers, clinics that lack equipment, and
long distances between people's homes and health-care centers have made
it difficult for people to receive treatment. In order for ART programs
to be effective, patients need to adhere to medication, be monitored
for drug toxicity, and continue to receive diagnosis and treatment of
infections. These requirements could be best met in Africa with limited
use of doctors and transportation, but instead the programs use lay
workers.
In
2001, researchers enrolled 466 HIV-infected adults and 1481
HIV-uninfected household members in Uganda in a study.
Daily co-trimoxazole prophylaxis (an antibiotic) was provided
to
HIV patients after five months. From May 2003 to December 2005, 138
infected eligible adults and 907 new HIV-infected participants and
their 3,120 HIV-negative household members began participating in an
ART study that provided therapy with stavudine, lamivudine,
and nevirapine. Lay providers visited households every week and
patients did not schedule any clinic visits after they enrolled in the
study.
Findings are summarized below:
233 (17%) of 1373 people with HIV and 40 (1%) of
4601 HIV-uninfected people died.
The death
rate in HIV-infected participants who had ART and co-trimoxazole was
55% lower than with co-trimoxazole alone during the first 16 weeks; 92%
lower after 16 weeks
There was a 95% reduction in mortality in HIV-infected
participants who had ART and co-trimoxazole compared to those who had
no intervention
An 81% reduction in mortality of uninfected children
younger than 10 years old was associated with participants who
received ART and co-trimoxazole compared to no intervention
Orphanhood was reduced by about 93% for children
of treated adults
"A home-based ART and
co-trimoxazole programme was associated with a greater than 90%
reduction in mortality in adults with HIV living in rural Uganda. These
results were achieved even though no routine clinic visits were
scheduled after initial enrolment, and home visits were provided by
trained lay providers. Provision of ART to adults was also associated
with a large reduction in mortality in their HIV-negative children, and
with substantial reductions in the rate of orphanhood...our findings
support the efforts to bring ART to people with HIV throughout the
world, irrespective of geographic or socioeconomic background,"
conclude the authors.
Dr Eline Korenromp (Global Fund to Fight Aids,
Tuberculosis and Malaria, Geneva, Switzerland, and University Medical
Center, Rotterdam, Netherlands) and Dr Jane Kengeya Kayondo
(UNICEF/UNDP/World Bank/WHO Special Program for Training in Tropical
Diseases) write in an accompanying commentary: "The studies embedded in
Mermin and colleagues'
programme show how operational research can successfully be done during
scale-up. We should hope that more and more prevention and treatment
programmes will use opportunities for optimising resource allocations
and service deliveries through learning by doing."
Mortality in HIV-infected Ugandan adults
receiving antiretroviral treatment and survival of their HIV-uninfected
children: a prospective cohort study
Jonathan
Mermin MD, Willy Were MB, John Paul Ekwaru MSc, David Moore MD, Robert
Downing PhD, Prosper Behumbiize, John R Lule MB, Alex Coutinho MB,
Jordan Tappero MD, and Rebecca Bunnell ScD
The Lancet
(2008). 371:752-759
doi:10.1016/S0140-6736(08)60345-1
Click
Here to View Abstract
Written by: Peter M Crosta
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
HIV, de mortalitate în þãrile sãrace-resurse reduse cu antiretrovirale program - HIV Mortality In Poor-Resource Countries Reduced By Antiretroviral Program - articole medicale engleza - startsanatate