Initiating antiretroviral treatment in a resource-constrained setting: does clinical staging effectively identify patients in need?
Identifieur interne : 000B13 ( Main/Exploration ); précédent : 000B12; suivant : 000B14Initiating antiretroviral treatment in a resource-constrained setting: does clinical staging effectively identify patients in need?
Auteurs : K. Torpey [Zambie] ; M. Lartey [Ghana] ; R. Amenyah [Ghana] ; N. A. Addo [Ghana] ; J. Obeng-Baah [Ghana] ; Y. Rahman [Ghana] ; C. Suzuki [États-Unis] ; Y. D. Mukadi [États-Unis] ; R. Colebunders [Belgique]Source :
- International journal of STD & AIDS [ 0956-4624 ] ; 2009.
Descripteurs français
- KwdFr :
- Adulte, Agents antiVIH (administration et posologie), Agents antiVIH (usage thérapeutique), Détermination de l'admissibilité (), Femelle, Ghana (épidémiologie), Humains, Infections à VIH (immunologie), Infections à VIH (physiopathologie), Infections à VIH (traitement médicamenteux), Mâle, Numération des lymphocytes CD4, Pays en voie de développement, Population rurale, Population urbaine, Sensibilité et spécificité, Valeur prédictive des tests, Évaluation des besoins.
- MESH :
- administration et posologie : Agents antiVIH.
- immunologie : Infections à VIH.
- physiopathologie : Infections à VIH.
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Agents antiVIH.
- épidémiologie : Ghana.
- Pascal (Inist)
- Adulte, Détermination de l'admissibilité, Femelle, Humains, Mâle, Numération des lymphocytes CD4, Pays en voie de développement, Population rurale, Population urbaine, SIDA, Maladie sexuellement transmissible, Antiviral, Antirétroviral, Sensibilité et spécificité, Traitement, Médecine, Homme, Valeur prédictive des tests, Évaluation des besoins.
- Wicri :
- geographic : Ghana.
- topic : Maladie sexuellement transmissible, Médecine, Homme.
English descriptors
- KwdEn :
- AIDS, Adult, Anti-HIV Agents (administration & dosage), Anti-HIV Agents (therapeutic use), Antiretroviral agent, Antiviral, CD4 Lymphocyte Count, Developing Countries, Eligibility Determination (methods), Female, Ghana (epidemiology), HIV Infections (drug therapy), HIV Infections (immunology), HIV Infections (physiopathology), Human, Humans, Male, Medicine, Needs Assessment, Predictive Value of Tests, Rural Population, Sensitivity and Specificity, Sexually transmitted disease, Treatment, Urban Population.
- MESH :
- chemical , administration & dosage : Anti-HIV Agents.
- chemical , therapeutic use : Anti-HIV Agents.
- geographic , epidemiology : Ghana.
- drug therapy : HIV Infections.
- immunology : HIV Infections.
- methods : Eligibility Determination.
- physiopathology : HIV Infections.
- Adult, CD4 Lymphocyte Count, Developing Countries, Female, Humans, Male, Needs Assessment, Predictive Value of Tests, Rural Population, Sensitivity and Specificity, Urban Population.
Abstract
In industrialized countries, the initiation of antiretroviral therapy (ART) is based on virological, immunological and clinical markers. The objective of this study was to identify treatment gaps when ART initiation is based on clinical staging alone. The method employed was a retrospective study of 5784 patients enrolled in an HIV treatment programme in two urban and two rural sites in Ghana. Of the patients, 29.5% were in clinical Stages I and II and had a CD4+ T-lymphocyte count less than 200 cells/mm3. Significantly more patients in clinical Stage I from urban sites (37.0%) had a CD4+ T-lymphocyte count less than 200 cells/mm3 as compared with patients from rural sites (23.8%) (P value <0.05). In addition, more men (39.9%) in clinical Stage I had a CD4+ T-lymphocyte count less than 200 cells/mm3 when compared with women (27.4%) (P value <0.05). In conclusion, clinical staging cannot identify a relatively large number of patients who need ART. A wider availability of CD4+ T-lymphocyte count testing will optimize the identification of patients eligible for ART.
Affiliations:
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Le document en format XML
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<term>Adult</term>
<term>Anti-HIV Agents (administration & dosage)</term>
<term>Anti-HIV Agents (therapeutic use)</term>
<term>Antiretroviral agent</term>
<term>Antiviral</term>
<term>CD4 Lymphocyte Count</term>
<term>Developing Countries</term>
<term>Eligibility Determination (methods)</term>
<term>Female</term>
<term>Ghana (epidemiology)</term>
<term>HIV Infections (drug therapy)</term>
<term>HIV Infections (immunology)</term>
<term>HIV Infections (physiopathology)</term>
<term>Human</term>
<term>Humans</term>
<term>Male</term>
<term>Medicine</term>
<term>Needs Assessment</term>
<term>Predictive Value of Tests</term>
<term>Rural Population</term>
<term>Sensitivity and Specificity</term>
<term>Sexually transmitted disease</term>
<term>Treatment</term>
<term>Urban Population</term>
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<term>Agents antiVIH (administration et posologie)</term>
<term>Agents antiVIH (usage thérapeutique)</term>
<term>Détermination de l'admissibilité ()</term>
<term>Femelle</term>
<term>Ghana (épidémiologie)</term>
<term>Humains</term>
<term>Infections à VIH (immunologie)</term>
<term>Infections à VIH (physiopathologie)</term>
<term>Infections à VIH (traitement médicamenteux)</term>
<term>Mâle</term>
<term>Numération des lymphocytes CD4</term>
<term>Pays en voie de développement</term>
<term>Population rurale</term>
<term>Population urbaine</term>
<term>Sensibilité et spécificité</term>
<term>Valeur prédictive des tests</term>
<term>Évaluation des besoins</term>
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<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anti-HIV Agents</term>
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<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term>
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<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Agents antiVIH</term>
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<keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>HIV Infections</term>
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<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Ghana</term>
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<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
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<term>Developing Countries</term>
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<term>Humans</term>
<term>Male</term>
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<term>Predictive Value of Tests</term>
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<term>Sensitivity and Specificity</term>
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<keywords scheme="Pascal" xml:lang="fr"><term>Adulte</term>
<term>Détermination de l'admissibilité</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Numération des lymphocytes CD4</term>
<term>Pays en voie de développement</term>
<term>Population rurale</term>
<term>Population urbaine</term>
<term>SIDA</term>
<term>Maladie sexuellement transmissible</term>
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<term>Antirétroviral</term>
<term>Sensibilité et spécificité</term>
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<term>Évaluation des besoins</term>
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<front><div type="abstract" xml:lang="en">In industrialized countries, the initiation of antiretroviral therapy (ART) is based on virological, immunological and clinical markers. The objective of this study was to identify treatment gaps when ART initiation is based on clinical staging alone. The method employed was a retrospective study of 5784 patients enrolled in an HIV treatment programme in two urban and two rural sites in Ghana. Of the patients, 29.5% were in clinical Stages I and II and had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup>
. Significantly more patients in clinical Stage I from urban sites (37.0%) had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup>
as compared with patients from rural sites (23.8%) (P value <0.05). In addition, more men (39.9%) in clinical Stage I had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup>
when compared with women (27.4%) (P value <0.05). In conclusion, clinical staging cannot identify a relatively large number of patients who need ART. A wider availability of CD4+ T-lymphocyte count testing will optimize the identification of patients eligible for ART.</div>
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