Docstoc

Wright - PowerPoint

Document Sample
Wright - PowerPoint Powered By Docstoc
					            The APNAC Study



NeuroAIDS in Asia and the Pacific Rim Symposium
                 Sydney, 2007

        Edwina Wright on behalf of APNAC
      Burnet Institute and The Alfred Hospital,
               Melbourne, Australia
www.allbigtrips.com
                  Estimated number of people living with HIV
                             in Asia, 1986–2006

                      10
            Million




                      8


Number                6
of people
living                4
with HIV
                      2

                      0
                           1986 1988   1990   1992 1994   1996   1998   2000   2002 2004   2006
                                                          Year




                                                                                   UNAIDS 2006
Towards Universal Access by 2010, WHO 2006
UNAIDS 2005
2010 Universal Access




http://www.who.int/hiv/universalaccess2010/
             Prevalence HIV Neurological Disease
                    in Asia Pacific Region
8.3
                      3 million              In western countries
million                                       1/3 of patients with
                      people in
                         Asia                       advanced,
HIV+                                              untreated HIV
                        Pacific                  disease develop
people                 Region                      neurological
                                                    disorders 4
                        have
live in
                     advanced,
the Asia                                         Thus  1 million
                       largely                    people at risk of
                     untreated                      HIV-related
Pacific                  HIV                       neurological
                     disease 2,3                   disease in AP
Region1                                               Region
                                                                                                      www.thebody.com/


 1. UNAIDS/WHO, AIDS Epidemic Update Dec 2005; 2. Zhou et al, J Acquir Immune Defic Syndr 2005. 3. UNAIDS/WHO,
 Progress on Global Access to Antiretroviral therapy. An update on 3X5, Dec 2005. 4. Snider et al Ann Neurol 1983
          Epidemiology: Prevalence
         Disorder                        Prevalence Asia                        Prevalence
                                          Pacific Region                         Western
                                                                              countries pre-
                                                                                  HAART
HIV AIDS Dementia                          “Uncommon”,                         10%- severe 4
                                           4.6%-35% 1,2,3,9                   25- 30% mild 5
                                         **Clade   C 9 and CRF
                                                 01_AE 10
HIV-related                                    Unknown                               40% 6, 7
Neurocognitive
Impairment
Symptomatic SN                              2.6%-6.4% 1, 2                            35% 8

1. Nakagawa et al, Int Med 1997; 2. Oh et al, CID 1999; 3. Satischandra et al, Indian J Med Res 2000; 4.
Portegies et al, AIDS 1993; 5. McArthur et al, Neurol 1993; 6. Sacktor et al, J Neurovirol 2002; 7. Cysique
et al, Arch Neurol 2004; 8. Schiffito et al, Neurol 2002; 9. Riedel, J Neurovirol, 2006; 10. Valcour et al,
Neurology 2007.
         Epidemiology: Prevalence
         Disorder                       Prevalence Asia                        Prevalence
                                         Pacific Region                          Western
                                                                                countries
                                                                               pre-HAART
Toxoplasmosis                                13.0%1                               10% 2
                                        14.8 100-person
                                             years 3
Cryptococcal                             7.0%-12.6% 4,5                             7.0% 7
Meningitis                              18.0 100-person
                                             years 6
Lymphoma                                  Uncommon                                  2-5% 8

1. Lanjewar et al, AIDS 1998; 2. Luft et al, CID, 1992; 3. Subsai et al, Eur J Neurol, 2004; 4. Personal
communication G. Tau; 5. Senya et al, Int J STD AIDS 2003 1993; 6.Subsai et al, Eur J Neurol, 2004; 7.
Powderly et al, CID, 1993; 8. Arribas et al, J Clin Micro 1995
     The Asia-Pacific NeuroAIDS
             Consortium
Formed 2002
– PNG
– Cambodia
– India
– Fiji
– Indonesia
                 UNAIDS: 2003

– Thailand
– Hong Kong
– Singapore
– Malaysia
– China
– Australia
       The Asia Pacific NeuroAIDS Consortium
                  (APNAC) Study


    Edwina Wright, Bruce Brew, Arkhom Arayawichanont, Kevin Robertson,
   Kanoksri Samintharapanya, Subsai Kongsaengdao, Megan Lim, Saphonn
  Vonthanak, Luxshimi Lal, Chel Sarim, Sarah Huffam, Patrick Li, Darma Imran,
Jenny Lewis, Wen Hui Lun, Adeeba Kamarulzaman, Goa Tau, Sophaginine Ty Ali,
 Kamal Kishore, Margaret Bain, Rosamond Dwyer, Gavin McCormack, Margaret
          Hellard, Kate Cherry, Justin McArthur, Steve Wesselingh
                                 on behalf of
                            the APNAC Study Team
    The APNAC Study: Aims
     To determine the prevalence of
•   HIV-related Neurocognitive Impairment
    (NCI)
•   Symptomatic Peripheral neuropathy (SN)
•   CNS-opportunistic disorders and HIV
    dementia
in HIV positive patients across the Asia
               Pacific Region
     The APNAC Study: MO
• Outpatient Study
  – HIV-related neurocognitive impairment
  – Symptomatic Sensory Neuropathy

• Inpatient Study
  – CNS-opportunistic disorders and HIV Associated
    Dementia
  Methods: Outpatient Study
• Cross-sectional study at 10 sentinel
  outpatient sites in 8 APNAC countries

• Standardised training at all sites

• Enrolled HIV+ outpatients and HIV
  negative controls for 2-3 week periods
                     10 APNAC Study
                     Sites
                         Ditan Hospital, Beijing, China
                         Queen Elizabeth Hospital, Hong Kong


                         Rajavithi Hospital, Bangkok, Thailand
                         Lumpang Hospital, Lumpang, Thailand
                         Sappasithiprasong Hospital, Ubon
                              Ratchathani, Thailand

                         Social Health Clinic, National Center for
                              HIV/AIDS, Dermatology and STDs,
                              Phnom Penh, Cambodia

                         Univ. of Malaya Medical Center, Kuala
                               Lumpur, Malaysia

                         Dr Cipto Mangunkusumo Hospital,
                               Jakarta, Indonesia

                         Port Moresby General Hospital, Port
                               Moresby, Papua New Guinea

                         Reproductive Health Clinic, Suva, Fiji




www.lib.utexas.edu
                   APNAC Study Tools
   • Neurocognitive Function
         – Neuropsychological test battery1
              •   Timed gait
              •   Grooved pegboard
              •   Finger tapper
              •   Semantic fluency
         – Depression screening tool: CES-D2,3,4
         – Alcohol and substance use questionnaire5,6
   • Symptomatic Peripheral Neuropathy
         – Brief Peripheral Neuropathy Screening Tool7

1. Price et al, AIDS 1999; 2. Radloff, Appl Psychol Meas 1977; 3. Cockram et al, Aust NZ J Med 1999; 4. Mackinnon et al,
J Gerontol B Psychol Sci Soc Sci 1998; 5.NHMRC Australian Alcohol Guidelines, 2001; 6. NIAAA. US Dept Health
Human Services 2005 ed. 7. Cherry et al, Neurol 2005.
                          Study Definitions
   • Neurocognitive Impairment
         – Patients were defined as impaired if they
           scored ≥-2SDs below the mean scores
           obtained from local HIV negative controls on
           two of the four neuropsychological tests1,2,3
   • Depression
         – A score >16 on CES-D screening tool4,5,6


1. Grunseit et al, J Clin Exp Neuropyschol 1994; 2. Cysique et al, J Neurovirol 2004; 3. Woods et al, Clin Exp
Neuropyschol 2004; 4. Radloff, Appl Psychol Meas 1977; 5. Cockram et al, Aust NZ J Med 1999; Mackinnon
et al, J Gerontol B Psychol Sci Soc Sci 1998.
             Study Definitions
Symptomatic Peripheral Neuropathy
• Definite
  – Symptoms plus absent ankle reflexes plus vibration
    sense at great toes 10 seconds
• Probable
  – Symptoms plus EITHER absent ankle reflexes OR
    vibration sense at great toes 10 seconds
  Results: Outpatient Study
July 2005 - March 2006
• 658 HIV+ outpatients and 161 HIV- controls
  enrolled
• 10 sites across 8 countries
  – 80% ARVs and 65% HAART
                              Results: Demography
                                         HIV infected    Controls   P-value*
                                         patients n(%)    n(%)

Total                                        658           161
Demographics
Gender
                                 Male      390 (59)      90 (56)
                               Female      268 (41)      71 (44)      0.41
Age mean (years)                              36           34         0.03
Education                                                            <0.01
          Less than high school, 6yrs       319 (48)      47 (30)
         High school graduate, 12 yrs       204 (31)      34 (21)
               Some college/university      79 (12)       21 (13)
               Bachelor Degree, 15 yrs       48 (7)       38 (24)
          Postgraduate Degree, 18yrs          5 (1)        9 (6)
                               Unknown       3 (0.5)      12 (7)
*P-value < 0.05 significant
                     Results: Demography
Total HIV+ outpatients n(%)                             658
Mode Acquisition n(%)
                                   Heterosexual       491 (75)
                                    Homosexual         72 (11)
                            Injecting Drug User        74 (11)
                                 Blood products         9 (1)
                                          Other        12 (2)
                                       Unknown         56 (8)
Recent CD4 count (n= 593) median (cells/ul)       203 IQR (95, 359)
Nadir CD4 count (n=539) median (cells/uL)         71 IQR (24, 440)
Prior AIDS illness n(%)                               426 (65)
Antiretroviral naïve n(%)                             107 (16)
Current use of HAART n(%)                             414 (65)
                                         Results
   • Neurocognitive Impairment: 12%
               • 76/647 patients
               • 65% receiving HAART
   • Depression: 36%
               • 235/645 patients
   • Symptomatic Sensory Neuropathy: 20%
               •   126/640 patients
               •   Definite (6%) and Probable (13%)
               •   63% patients had prior or current use d-drugs1
               •   26% patients were receiving pain relief



1. d-drugs: stavudine, didanosine or zalcitabine
                                 Prevalence of Neurocognitive Impairment,
                                  Symptomatic Sensory Neuropathy and
                                            Depression by Site

 Site               BK            Beijing       Hong           Jakarta          Kuala           Lumpang         Phnom           Port            Suva            Ubon            Total
                                                Kong                            Lumpur                          Penh            Moresby


                    13/73           2/49          14/61            7/61            2/39          13/115            4/91            6/33           0/10           15/115          76/647
 NCI   *            (18%)           (4%)          (23%)           (11%)            (5%)          (11%)             (4%)           (18%)           (0%)           (13%)           (12%)




 Depressn           10/68           8/50          57/62          19/60             8/40          31/115           30/92           13/34           4/10           55/114         235/645
 †                  (15%)          (16%)          (92%)          (32%)            (20%)          (27%)            (33%)           (38%)          (40%)           (48%)           (36%)




 Sypx SN            20/68          13 /50          9/62          10/60             8/40          22/111            5/92            9/34           2/10           28/113         126/640
 ‡                  (30%)          (26%)          (14%)          (17%)            (20%)          (11%)             (5%)           (26%)          (20%)           (25%)           (20%)




 * Neurocognitive impairment defined as ≥-2SDs below local control means in two of the four neuropsychological tests
† A CES-D score greater than 16 on the Center for Epidemiological Depression Scale of 20 items strongly suggests underlying depression.
‡Symptomatic sensory neuropathy defined as either definite SN: symptoms plus absent ankle reflexes plus vibration sense ≤10 second at great toes or probable SN: symptoms plus absent ankle
reflexes or vibration sense ≤10 second at great toes. The total number of patients with definite and probable symptomatic SN has been combined in this table.
                        Risk Factors for NCI, Depression and SN
 Total HIV+ outpatients n=658                              Result              NCI            Depression             SN
                                                                             P-value*          P-value             P-value
 Age1 mean (years)                                           36                <0.01              0.19              <0.01

 Diagnosis NCI n/n evaluable (%)                         76/647 (12)            ---               0.11              <0.01
 Diagnosis depression n/n evaluable (%)                 235/645 (36)           0.11                ---               0.01
 Diagnosis SN n/n evaluable (%)                           126 (19)             <0.01              0.02                ---

 Prior AIDS illness n(%)                                  426 (65)             <0.01             <0.01               0.01
 Nadir CD4 cell count median (cells/uL)                      71                0.93               0.58               0.45

 Current use of HAART n(%)                                414 (65)             0.84               0.49              <0.01
 Prior AIDS-related CNS disease n(%)                       57 (9)              0.54               0.24               0.96
 Education level < high school n(%)                      319 (48%)             0.08              <0.01               0.28

 Excess alcohol use in past 6 months n(%)                   7 (1)                #                  #                  #

 Substance use in past 6 months n(%)                       25 (4)                #                  #                  #

 Hepatitis C Ab positive n/n tested (%)                  51/266 (20)           0.79               0.19               0.94
 Use of d-drugs Current use, Ever used                 296 (45), 52 (8)         ---                ---            0.01, <0.01

 Use of pain relief n/n evaluable (%)                    84/636 (13)           0.06               0.63              <0.01
 Diabetes 3 n(%)                                           15 (2)               ---                ---               0.15
 Current use anti-tuberculous therapy n(%)                167 (25)              ---                ---               0.68

1. Univariate analysis: Age:>35 years; 2. Univariate analysis: CD4 nadir (mean):> 80 cells/uL ; 3. Diabetes: defined as
diagnosis of diabetes or use of diabetic drugs; # numbers too small to be included in univariate analysis. * significance= p value
< 0.05
                 Risk Factors for NCI, Depression and SN
Total HIV+ outpatients         NCI             Depression              SN
n=658                      Adjusted OR         Adjusted OR         Adjusted OR
                              95%CI               95%CI               95%CI
                             P-value             P-value             P-value
Age >35 years             1.85 (1.08,3.15)           ns           1.81 (1.18, 2.77)
                                0.02                                    <0.01
Diagnosis NCI                    ---                 ns           2.16 (1.23, 3.80)
                                                                        <0.01
Diagnosis depression             ns                  ---                 ns

Diagnosis SN              2.24 (1.28,3.91)    1.54 (1.19, 3.79)          ---
                               <0.01                0.01

Prior AIDS illness        2.05 (1.11,3.76)    1.63 (1.12, 2.37)          ns
                                0.02                0.01
Education level < high          0.02          1.67 (1.19, 2.35)          ns
school                                              <0.01
         Use of d-drugs          ---                 ---                 ns
                Current                                           3.2 (1.56, 6.55)
                   Ever                                                <0.01
Use of neuroHAART         0.55 (0.32, 0.95)          ns                   -
                                0.03
   APNAC Inpatient Study: Methods
• Cross-sectional study at 8 study sites
  – Fiji, Papua New Guinea, Malaysia, Indonesia,
    Thailand, Hong Kong
• HIV+ hospital inpatients
  – Consecutively enrolled over a 2-3 week period at
    each site
• Case Records
  – Clinical data, laboratory and neuroimaging
    investigations, working diagnoses and treatment
     APNAC Inpatient Study: Methods

• Definition HIV+ inpatient with a neurological
  diagnosis:
  – Those patients who received treatment for a
    neurological disorder
  AND had 2 or more of the following-
     • Presented with features suggesting either
       encephalitis, meningitis, space occupying lesion,
       seizure, cerebrovascular accident or other
     • Received targeted neurological investigations
     • Had results compatible with a neurological
       diagnosis
     • Had a documented neurological diagnosis written
       in case records
APNAC Inpatient Study: Results
     160 HIV+ inpatients enrolled

•Neurological diagnosis: 68/160 (43%)

•Median CD4+ cell count: 18 cells/µL (1-917
cells/µL), (n= 42 tested)

•Receiving HAART at presentation: 26/68
(32%)
APNAC Inpatient Study: Results
  Commonest neurological diagnoses

•Cryptococcal meningitis: 21/72 (29%)

•Cerebral toxoplasmosis: 20/72 (28%)

•Miscellaneous: (strokes, spinal TB, tuberculoma,
other) 12/72 (17%)

•Tuberculous meningitis: 10/72 (14%)

•Seizures: 5/72 (7%)

•Aseptic/bacterial meningitis: 4/72 (6%)
    APNAC Inpatient Study: Results
Investigational profiles
    – Cryptococcal meningitis n=21
       •   CT scan: 4
       •   CSF culture: 17
       •   CSF cryptococcal antigen: 20
       •   Indian ink stain: 17
    – Cerebral toxoplasmosis n=19
       • CT scan: 17
       • Serum toxoplasma IgG: 4
    – TB meningitis n=10
       • CT scans: 4
       • CSF ZN stain: 1
       • CSF TB culture: 1
•   56% patients had CT/MRI brain
Variable                         CNS diagnosis           Non-CNS              Unadjusted OR           Adjusted OR
                                 N=68 (%)                diagnosis            (95%CI)                 (95% CI)
                                                         N=92 (%)             P value                 P value

Gender
                       Female          29 (41%)                39 (44%)        0.9 (0.5-1.7) p>0.7         NS

Current CD4+ cell count
(cells/μL)
(n=102)
                           ≤50            25                      28          0.8 (0.22-2.8) p>0.7         NS
                        50-100            5                        7          0.7 (0.34-2.4) p>0.62        NS
                       100-200            6                        9          0.5 (0.2-1.5) p>0.22         NS


Nadir CD4 cell count
(cells/μL)
(n=57)
                           ≤50            35                      29          0.8 (0.3-2.5) p>0.7          NS
                        50-100            8                        8          0.6 (0.13-3.0) p>0.5         NS
                       100-200            4                        7          0.3 (0.3-2.8) p>0.3          NS
                          >200            8                        4          1.6 (0.4-6.0) p>0.44         NS

Prior ADI *                            59 (87%)                70 (76%)        1.3 (0.6-2.3) p>0.5         NS
Prior CNS ADI*                         27 (40%)                 7 (8%)            7.2 (2.9-17.8)      10.3 (3.8-27.5)
                                                                                     p>0.000             p>0.000

HAART** use                            26 (38%)                21 (23%)           1.8 (0.9-3.7)            NS
                                                                                     p>0.07

Hepatitis C Antibody +                 26 (38%)                25 (27%)           1.5 (0.8-3.0)        2.1 (1.0-4.4)
                                                                                     p>0.2                p>0.05

Co-trimoxazole prophylaxis             33 (48%)                45 (49%)        0.9 (0.5-1.6) p>0.6         NS

Fluconazole prophylaxis                25 (37%)                24 (26%)        1.5 (0.8-3.0) p>0.3         NS
Mode of HIV acquisition
               Heterosexual               48                      63           1.0 (0.06-1.3) p>0.9        NS
               Homosexual                  2                      10          0.3 (0.06-1.3) p>0.09        NS

                           IDU            17                       8          2.8 (1.1-7.0) p>0.03         NS


*ADI: AIDS-defining illness **HAART: Highly active antiretroviral treatment
                       Discussion
• HIV-related neurological disorders are
  prevalent in the Asia Pacific Region
  –   HIV-related Neurocognitive Impairment: 12%
  –   Symptomatic Sensory Neuropathy: 20%
  –   Depression: 36%
  –   43% hospital inpatients had neurological diagnosis
       • Cryptococcal meningitis and toxoplasmosis are the commonest
         diagnoses
  – Prior CNS ADI and hepatitis C antibody positivity were
    significantly associated with CNS inpatient diagnosis
  Discussion: Outpatient Study
• 2/3 had prior AIDS illnesses

• NCI, Depression and SN under-diagnosed
  – NCI and depression => Poor adherence
  – NCI=>Increased risk job loss
  – Poor QOL with SN

• D-drug use significantly associated with
  symptomatic SN
  – Alternative treatment options/strategies required
  Discussion: Inpatient Study
• Neurological inpatient group severely
  immunosuppressed
  • 1/3 receiving HAART at presentation

• Commonest diagnoses opportunistic CNS
  infections
  • No diagnosis HIV dementia/ lymphoma

• Prior CNS ADI significantly predicts inpatient
  neurological diagnosis
                      APNAC Study Team
Dept Medicine, Sappasithiprasong Hospital,        Beijing Ditan Hospital, Beijing, China
Ubonratchathani, Thailand                         Wen Hui Lun, Guang Zeng, Key Xu
Arkhom Arayawichanont
                                                  University Malaya Medical Center, Kuala Lumpur,
Dept Neurology, University North Carolina, NC     Malaysia
USA                                               Adeeba Kamarulzaman, Clarence Sim
Kevin Robertson
                                                  Port Moresby General Hospital, Port Moresby PNG
Dept Internal Medicine, Division of Neurology,    Goa Tau
Lumpang Hospital, Muang District, Thailand
Kanoksri Samintarapanya, Panita Pathipvanich      Reproductive Health Clinic and Colonial War Memorial
                                                  Hospital, Suva Fiji
Division of Neurology, Dept Medicine, Rajavithi   Sophaginine Ty Ali, Kamal Kishore
Hospital Bangkok, Thailand
Subsai Kongsaengdao                               Dept Neurology, The Johns Hopkins Hospital, Baltimore,
                                                  USA Justin McArthur, Sandy Zhang
National Centre HIV/AIDS, STD and Dermatology
Social Health Clinic, Phnom Penh Cambodia     St Vincent’s Hospital, Sydney, Australia Bruce Brew,
Saphonn Vonthanak, Chel Sarim, Sarah Huffam Margaret Peggy Bain
                                                  Burnet Institute, Melbourne, Australia Steve Wesselingh,
Queen Elizabeth Hospital, Hong Kong               Luxshimi Lal, Megan Lim, Jenny Lewis, Darshini
Patrick Li, Iris Chen                             Devadson, Margaret Hellard, Gavin McCormack

Dr Cipto Mangunkusomo Hospital, Jakarta,          The Alfred Hospital, Melbourne, Australia Rosamond
Indonesia Darma Imran, Jofizal Jannis             Dwyer, Craig Scholten, Teresa Girke, Jenny Hoy, Sharon
                                                  Lewin, Edwina Wright

                       Study funded by NINDS and NIMH, NIH
END
                 Study Numbers

                 Outpatients    Predicted       95%
                  required     prevalence   confidence
                                             intervals
Peripheral          370          15%*        11.2-18.5
neuropathy

Neurocognitive      370          15%*        11.2-18.5
impairment
      Study Definitions: Depression,
       Substance and Alcohol Use
• Significant risk of underlying depression
  – Score > 16 on CESD-20 Screening tool
• Excess alcohol intake
  – More than 4 standard drinks on 4-7 days per week in
    preceding 6 months
• Significant substance use
  – Use of amphetamines, heroin, ketamine, LSD,
    marijuana, MDMA, methamphetamine, PCP, crack
    cocaine in the preceding 6 months
         Statistical Methods
• Controls
  – Student t-test and chi-square
• Univariate analysis
  – Chi-square test and Fisher’s exact test
  – Current CD4 cells < 200/uL, Nadir CD4 cell count,
    Prior ADI, Prior CNS AIDS illness, Prior head
    injury, Education level less than high school, CES-
    D score >16, Use of pain medication, Use of ARVs
    (none, <3, >3), Use of neuroHAART, Hepatitis C
    antibody positivity, Diagnosis of SN, Diagnosis of
    NCI
• Multivariate analysis
  – Logistic regression
Variable                                CNS diagnosis     Non-CNS diagnosis
                                        N=68 (%)          N=92 (%)
                              Gender           39 (57%)          50 (54%)
                                Male           29 (43%)          42 (46%)
                              Female
Age                                             33yrs              37yrs
              Mode of HIV acquisition
                         Heterosexual             48                63
                         Homosexual                2                10
                                 IDU              17                 8
                       Blood products              0                 3
                                Other              0                 1
  Current CD4+ cell count (cells/μL)
                            (n=102)
                                 ≤50              25                28
                             50-100                5                 7
                            100-200                6                 9
                               >200                7                15
      Nadir CD4 cell count (cells/μL)
                              (n=57)
                                  ≤50             35                29
                              50-100               8                 8
                             100-200               4                 7
                                >200               8                 4
Prior ADI *                                    59 (87%)          70 (76%)
Prior CNS ADI*                                 27 (40%)           7 (8%)
HAART** use                                    26 (38%)          21 (23%)
Hepatitis C Antibody +                         26 (38%)          25 (27%)
Co-trimoxazole prophylaxis                     33 (48%)          45 (49%)
Fluconazole prophylaxis                        25 (37%)          24 (26%)
Variable                               CNS diagnosis   Non-CNS diagnosis
                                         N=68 (%)          N=92 (%)
Gender
                           Male           39 (57%)         50 (54%)
                         Female           29 (43%)         42 (46%)
Age                                         33yrs            37yrs
Mode of HIV acquisition
                 Heterosexual                 48              63
                 Homosexual                    2              10
                         IDU                  17               8
               Blood products                  0               3
                        Other                  0               1
Current CD4+ cell count
(cells/μL)
(n=102)
                             ≤50              25              28
                          50-100               5               7
                         100-200               6               9
                            >200               7              15
Nadir CD4 cell count
(cells/μL)
(n=57)                                        35              29
                             ≤50               8               8
                          50-100               4               7
                         100-200               8               4
                            >200
Prior ADI *                               59 (87%)         70 (76%)
Prior CNS ADI*                            27 (40%)          7 (8%)
HAART** use                               26 (38%)         21 (23%)
Hepatitis C Antibody +                    26 (38%)         25 (27%)
Co-trimoxazole prophylaxis                33 (48%)         45 (49%)
Fluconazole prophylaxis                     25 (37%)       24 (26%)
*ADI: AIDS-defining illness
**HAART: Highly active antiretroviral treatment

				
DOCUMENT INFO