Peterson K.,Institute of Tropical Medicine |
Togun T.,Medical Research Council UK the Gambia Unit |
Klis S.,University of Groningen |
Menten J.,Institute of Tropical Medicine |
And 2 more authors.
AIDS Patient Care and STDs | Year: 2012
Mood disorders are more frequent among people with HIV infection than among non-HIV-infected individuals of the same age, socioeconomic status, and HIV risks. They have been associated with worse adherence and clinical outcomes, yet remain underdiagnosed and undertreated in sub-Saharan Africa. We explored the relationship between mood disorders using the 10-item depression scale of the Centers for Epidemiological Studies (CES-D10) and the 22-item Impact of Events Scale-Revised (IES-R) for posttraumatic stress disorder, and a range of demographic and HIV-related variables among 252 consecutive subjects on antiretroviral therapy (ART). The study was conducted in the Genito-Urinary Medicine Clinic of the Medical Research Council's Gambia Unit. These screening tests were positive in 7% and 30%, respectively, of the patients, with higher scores (more depression or more post-traumatic stress) associated with female gender, more advanced WHO clinical stage, and lower Karnofsky Perfomance Scale rating. Higher CES-D10 scores were also seen among those on their second ART regimen. No relationship was seen with age, time on ART, viral load, or CD4 cell count. Compared to an earlier study at the same site in subjects prior to starting ART, the prevalence of depression in those stabilized on ART was dramatically reduced (by 34%, from 41%) while that of PTSD dropped less (by 13%, from 43%). Integrating the CES-D10 or a similar instrument into patient preparation for ART is recommended in order to identify those who may benefit from further mental health investigations, specific therapy, or closer follow-up during early ART. © 2012, Mary Ann Liebert, Inc.
Peterson I.,University of Swaziland |
Togun O.,Medical Research Council UK the Gambia Unit |
De Silva T.,University of Swaziland |
De Silva T.,University College London |
And 7 more authors.
AIDS | Year: 2011
OBJECTIVES:: This study's objective was to assess outcomes in HIV-1 and HIV-2 infected antiretroviral therapy (ART)-naïve patients starting ART in the Gambia, West Africa. DESIGN:: A cohort design was used to estimate survival in ART patients and determine whether survival and time to virologic failure varied across patient subgroups. METHODS:: Mortality, virologic failures and CD4 cell recovery were assessed in a clinical cohort of patients from the Genito-Urinary Medicine (GUM) clinic of the MRC Laboratories in the Gambia. Kaplan-Meier estimates of survival were determined for mortality and virologic failure. A Cox proportional hazards model was used to identify baseline demographic, clinical, immunologic and virologic factors associated with increased risk of death. RESULTS:: The overall Kaplan-Meier estimate of survival to 36 months was 73.4% (66.5, 80.3). Survival was marginally higher in HIV-2-infected patients compared to HIV-1-infected patients; it was significantly higher in patients with a baseline CD4 lymphocyte cell count of greater than 50 cells/μl compared to those with a baseline CD4 count of less than 50 cells/μl. CD4 cell recovery was faster in HIV-1-infected individuals compared to HIV-2-infected patients up to 24 months, although this did not result higher mortality in the latter group. No differences in virologic failure were observed by HIV type. CONCLUSION:: HIV-1 and HIV-2-infected patients receiving ART in a clinical setting in the Gambia had good survival to 36 months. HIV-2-infected patients did as well as HIV-1-infected patients in terms of long-term immunological and virological responses and overall survival. © 2011 Wolters Kluwer Health Lippincott Williams & Wilkins.