Delay of antiretroviral therapy initiation is common in East African HIV-infected individuals in serodiscordant partnerships.
Delay of antiretroviral therapy initiation is common in East African HIV-infected individuals in serodiscordant partnerships.
复制标题
DOI：
10.1097/qai.0000000000000192
复制
发表时间：
2014-08-01
期刊：
影响因子：
--
通讯作者：
Partners PrEP Study Team
中科院分区：
文献类型：
--
作者：
Mujugira A;Celum C;Thomas KK;Farquhar C;Mugo N;Katabira E;Bukusi EA;Tumwesigye E;Baeten JM;Partners PrEP Study Team
WHO guidance recommends antiretroviral therapy (ART) initiation for all persons with a known HIV-uninfected partner, as a strategy to prevent HIV transmission. Uptake of ART among HIV-infected partners in serodiscordant partnerships is not known, which we evaluated in African HIV serodiscordant couples. Prospective cohort study. Among HIV-infected persons from Kenya and Uganda who had a known heterosexual HIV-uninfected partner, we assessed ART initiation in those who became ART-eligible under national guidelines during follow-up. Participants received quarterly clinical and semi-annual CD4 monitoring, and active referral for ART upon becoming eligible. Of 1958 HIV-infected ART-eligible partners, 58% were women and the median age was 34 years. At the first visit when determined to be ART eligible, the median CD4 count was 273 cells/μL (IQR 221, 330), 77% had WHO stage 1 or 2 HIV disease, and 96% were receiving trimethoprim-sulfamethoxazole prophylaxis. The cumulative probabilities of initiating ART at 6, 12, and 24 months after eligibility were 49.9%, 70.0% and 87.6%, respectively. Younger age (<25 years) (adjusted hazard ratio [AHR] 1.39, p=0.001), higher CD4 count (AHR 1.95, p<0.001 for >350 compared with <200 cells/μL), higher education (AHR 1.25, p<0.001), and lack of income (AHR 1.15, p=0.02) were independent predictors for delay in ART initiation. In the context of close CD4 monitoring, ART counseling, and active linkage to HIV care, a substantial proportion of HIV-infected persons with a known HIV-uninfected partner delayed ART initiation. Strategies to motivate ART initiation are needed, particularly for younger persons with higher CD4 counts.
