WEPE044 - Poster Exhibition
Provision of long-lasting insecticide treated bednets and a point of use water filter to delay HIV-1 disease progression
J. Walson1,2, B. Singa2, J. Naulikha2,3, B. Piper2,4, K. Yuhas5, L. Sangaré4, F. Onchiri6, P. Otieno2, B. Richardson7,8, G. John-Stewart9
1University of Washington, Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, Seattle, United States, 2Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya, 3University of Washington, Pediatrics, Seattle, United States, 4University of Washington, Global Health, Seattle, United States, 5University of Washington, Seattle, United States, 6University of Washington, Epidemiology, Seattle, United States, 7University of Washington, Biostatistics, Global Health, Seattle, United States, 8Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 9University of Washington, Global Health, Medicine, Epidemiology and Pediatrics, Seattle, United States
Background: Among HIV-1 infected individuals in
Africa, endemic diseases, including malaria and water-borne pathogens, are
common and may drive HIV-1 disease progression.
We sought to determine whether the provision of a long lasting
insecticide-treated bednet (LLIN) and a simple point-of-use water filter to
HIV-1 infected adults delays HIV-1 disease progression.
Methods: HIV-1 infected adults not yet
meeting criteria for antiretroviral therapy were enrolled into a prospective cohort study in
Kenya. One group received standard care, while the second group (at the same
sites) received LLIN and water filter. Individuals
were followed for up to 24 months with CD4 counts collected every 6 months. The primary measure of efficacy was time to
CD4 count < 350 cells/mm3 controlling for initial CD4 count. Time to disease progression was compared
using Cox proportional hazards regression.
Results: Of 589 individuals included, 361 received
the intervention and 228 served as controls.
Most participants were female (81%) and had limited access to clean
water or sanitation (97.3%). Median baseline
CD4 counts (531 (LLIN) vs. 552 (control) cells/mm3) were similar
between groups (p=0.36). After
controlling for baseline CD4 count, individuals receiving LLIN and filters were
27% less likely to reach the endpoint of CD4 count < 350 cells/mm3
(HR 0.73 (0.57, 0.95) p=0.017). These
differences remained significant when controlling for sanitation and
cotrimoxazole use. CD4
decline was also significantly less in the group receiving LLIN and filters
than in the control group (-54 vs. -70 cells/mm3/year, p=0.03).
Conclusions: The provision of LLIN and a water
filter in the context of routine HIV care is associated with a significant
delay in CD4 decline and represents a simple, practical and cost-effective
method to delay HIV-1 progression in many settings.
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