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Immunologic Response to Highly Active Antiretroviral Therapy and Mortality Reduction in a Cohort of Human Immunodeficiency Virus–Positive Persons in Mozambique

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  • Department of Public Health and Cellular Biology, University Tor Vergata, Rome, Italy; Department of Infectious, Parasitic and Immunomediated Diseases, and Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy; Drug Resources Enhancement against AIDS and Malnutrition Program Coordination, Maputo, Mozambique; Training Unit, University Libera Maria Ss. Assunta, Rome, Italy
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Since February 2002, the Drug Resources Enhancement against AIDS and Malnutrition Program has provided highly active antiretroviral therapy (HAART) and immunologic and virologic monitoring free of charge. We conducted a cohort study of persons infected with human immunodeficiency virus in Mozambique. Only persons treated with HAART with available CD4 cell counts at baseline and ≥ 1 CD4 cell count after HAART were included. Survival analysis was applied to evaluate the prognostic value of CD4 cell counts measured at three months. Possible confounders were considered. A total of 753 persons who started HAART included; 59% were females. Median age was 34 years (range = 16–67 years), and the median CD4 cell count at baseline was 172 cells/mm (interquartile range = 87–261 cells/mm, range = 0–1,322 cells/mm). Overall, 105 persons (14%) died. Of these persons 54 (51%) developed AIDS before they died; 25 (3%) died during the first three months. After three months of therapy, the individual median CD4 cell count change from the baseline value was +101 cells/mm (interquartile range = +27 to +187 cells/mm, range = –723 to +310 cells/mm). A median CD4 increment of 100 cells/mm in three months was associated with a mortality reduction of 50% compared with an increase of < 50 cells (relative hazard of death adjusted for baseline CD4 cell count = 0.54, 95% confidence interval = 0.30–0.95). A good initial response to HAART was associated with a significant reduction of mortality. This finding supports the effectiveness of HAART in resource-poor settings.

Author Notes

*Address correspondence to Maria Dorrucci, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy. E-mail: maria.dorrucci@iss.it

Authors' addresses: Leonardo Palombi, Paola Scarcella, Sandro Mancinelli, and Ersilia Buonomo, Department of Public Health and Cellular Biology, University Tor Vergata, Rome, Italy. Maria Dorrucci and Giovanni Rezza, Department of Infectious, Parasitic, and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy. Ines Zimba, Drug Resources Enhancement against AIDS and Malnutrition Program Coordination, Maputo, Mozambique. Giovanni Guidotti, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy. Maria C. Marazzi, Training Unit, University Libera Università Maria Ss. Assunta, Rome, Italy.

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