TY  - BOOK
AU  - Kabangila Rodrick
AU  - Samuel Kalluvya
AU  - Erasmus Kamugisha
TI  -  Incidence and Risk Factors for Opportunistic Conditions in the First Three Months of Antire Troviral Therapy at Bugando Medical Centre in Mwanza Tanzania
PY  - 2009///
CY  - Mwanza, Tanzania  
PB  - St. Augustine University of Tanzania 
KW  -  
N2  - Abstract:

Background: Immune reconstitution which involves an increase in functional CD4 cells following suppression of viral load and thus decreased susceptibility to opportunistic conditions in one of primary goals of highly active antiretroviral therapy. However, it has been shown that immune reconstitution may trigger an inflammatory reaction in some people leading to worsening and unmasking of opportunistic conditions while on antiretroviral therapy. The information regarding risk factors and magnitude of worsening of previously diagnosed and new opportunistic conditions while on antiretroviral therapy in developing countries where opportunistic conditions are prevalent is scanty.

Method: This prospective study was conducted to determine incidence and risk factors of worsening of previously diagnosed and new opportunistic conditions among HIV infected patients in the first twelve weeks after initiating highly active antiretroviral therapy. The study was conducted between July and December 2008 at the Bugando Medical Centre in Mwanza, Tanzania. 

Results: The overall incidence rate was 40.91 cases per 100 person years and that of paradoxical opportunistic condition-associated IRIS was found to be 4.70 cases per 100 person years respectively. Taken as a whole, Tuberculosis and Herpes simplex viral infections were leading with incidence rates of 12.54 cases per 100 person years and the least incidence rate of 2.33 cases per 100 person years was observed in Toxoplasma encephalitis. The median time of opportunistic condition occurrence for all diseases was 35 (4 – 112) days. However, tuberculosis tended to occur earliest with median of 14 (8-80) days while Kaposi’s sarcoma was the latest with onset of 107 (14 – 112) days. Patients with baseline CD4 cells of 50 or less and those aged 35-44 years were significantly found to be more likely to develop opportunistic conditions in the first 3 months following ART. 

Conclusion: Incidence rate of paradoxical opportunistic conditions-associated IRIS was found to be roughly the same as that reported earlier, though overall incidence was much higher than that reported previously. Very low CD4 cells and younger age were significantly associated with occurrence of new opportunistic conditions and worsening of previously diagnosed opportunistic conditions. 
Recommendations: Based on new consensus case definitions, further prospective hospital based and community based studies on demographic, epidemiological, immunological, microbial and clinical characteristics are imperative to assess the incidence, prevalence and correlates of IRIS and ART-associated opportunistic conditions in Mwanza, Tanzania and sub-Saharan Africa in general

ER  -