| dc.contributor |
Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015 Paris, France. |
|
| dc.creator |
Madec, Y |
|
| dc.creator |
Laureillard, D |
|
| dc.creator |
Pinoges, L |
|
| dc.creator |
Fernandez, M |
|
| dc.creator |
Prak, N |
|
| dc.creator |
Ngeth, C |
|
| dc.creator |
Moeung, S |
|
| dc.creator |
Song, S |
|
| dc.creator |
Balkan, S |
|
| dc.creator |
Ferradini, L |
|
| dc.creator |
Quillet, C |
|
| dc.creator |
Fontanet, A |
|
| dc.date |
2007-01-30 |
|
| dc.date.accessioned |
2017-01-31T07:13:46Z |
|
| dc.date.available |
2017-01-31T07:13:46Z |
|
| dc.identifier |
Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia. 2007, 21 (3):351-9 AIDS |
|
| dc.identifier |
0269-9370 |
|
| dc.identifier |
17255742 |
|
| dc.identifier |
10.1097/QAD.0b013e328012c54f |
|
| dc.identifier |
http://hdl.handle.net/10144/52733 |
|
| dc.identifier |
http://fieldresearch.msf.org/msf/handle/10144/52733 |
|
| dc.identifier |
AIDS (London, England) |
|
| dc.identifier.uri |
http://dspace.mediu.edu.my:8181/xmlui/handle/10144/52733 |
|
| dc.description |
BACKGROUND: HAART efficacy was evaluated in a real-life setting in Phnom Penh (Médecins Sans Frontières programme) among severely immuno-compromised patients. METHODS: Factors associated with mortality and immune reconstitution were identified using Cox proportional hazards and logistic regression models, respectively. RESULTS: From July 2001 to April 2005, 1735 patients initiated HAART, with median CD4 cell count of 20 (inter-quartile range, 6-78) cells/microl. Mortality at 2 years increased as the CD4 cell count at HAART initiation decreased, (4.4, 4.5, 7.5 and 24.7% in patients with CD4 cell count > 100, 51-100, 21-50 and < or = 20 cells/microl, respectively; P < 10). Cotrimoxazole and fluconazole prophylaxis were protective against mortality as long as CD4 cell counts remained < or = 200 and < or = 100 cells/microl, respectively. The proportion of patients with successful immune reconstitution (CD4 cell gain > 100 cells/microl at 6 months) was 46.3%; it was lower in patients with previous ART exposure [odds ratio (OR), 0.16; 95% confidence interval (CI), 0.05-0.45] and patients developing a new opportunistic infection/immune reconstitution infection syndromes (OR, 0.71; 95% CI, 0.52-0.98). Similar efficacy was found between the stavudine-lamivudine-nevirapine fixed dose combination and the combination stavudine-lamivudine-efavirenz in terms of mortality and successful immune reconstitution. No surrogate markers for CD4 cell change could be identified among total lymphocyte count, haemoglobin, weight and body mass index. CONCLUSION: Although CD4 cell count-stratified mortality rates were similar to those observed in industrialized countries for patients with CD4 cell count > 50 cells/microl, patients with CD4 cell count < or = 20 cells/microl posed a real challenge to clinicians. Widespread voluntary HIV testing and counselling should be encouraged to allow HAART initiation before the development of severe immuno-suppression. |
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| dc.language |
en |
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| dc.rights |
Published by Wolters Kluwer Lippincott Williams & Wilkins Archived on this site by kind permission Wolters Kluwer |
|
| dc.title |
Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia. |
|