Advanced HIV disease in the Botswana combination prevention project: prevalence, risk factors, and outcomes

Objective(s): To determine the proportion of individuals linking to HIV-care with advanced HIV-disease (CD4+ cell counts ≤200 cells/μl) in the Botswana Combination Prevention Project, describe the characteristics of these individuals, and examine treatment outcomes. Design: A subanalysis of a cluster-randomized HIV-prevention trial. HIV status was assessed in 16–64-year-olds through home and mobile testing. All HIV-positive persons not on antiretroviral therapy were referred to local Ministry of Health and Wellness clinics for treatment. Methods: Analysis was restricted to the 15 intervention clusters. The proportion of individuals with advanced HIV disease was determined; associations between advanced HIV disease and sex and age explored; and rates of viral suppression determined at 1-year. Mortality and retention in care were compared between CD4+ strata (CD4+ cell counts ≤200 vs.>200 cells/μl). Results: Overall, 17.2% [430/2499; 95% confidence interval (CI) 15.7–18.8%] of study participants had advanced HIV disease (CD4+ cell counts ≤200 cells/μl) at time of clinic linkage. Men were significantly more likely to present with CD4+ cell counts 200 cells/μl or less than women [23.7 vs. 13.4%, adjusted odds ratio 1.9, 95% CI 1.5–2.3]. The risk of advanced HIV disease increased with increasing age (adjusted odds ratio 2.2, 95% CI 1.4–3.2>35 vs.
Source: AIDS - Category: Infectious Diseases Tags: CLINICAL SCIENCE Source Type: research