XIX International AIDS Conference


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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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