Factors associated with HIV Disease Progression in Discordant Couples, Rwanda 2002-2012 Open Access

Annis, Ayano (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/bc386k444?locale=en


Background: It is unknown why disease progression happens slower or faster than other people. There are studies that suggest different exposures, such as co-infections, women’s hormonal injectable contraception use, increased age could change HIV disease progression speed.

Methods: From 1994 to 2012, HIV discordant couples were recruited from Kigali, Rwanda to receive couples’ HIV counseling and testing services and were followed up every 3 months. Multivariable analysis were used to determine associations between different exposures and three HIV disease progression outcomes: (1) time to all-cause death among HIV positive partners, (2) time to ART initiation among HIV positive partners, and (3) a composite of the prior two outcomes.

Results: When comparing HIV+ males and HIV+ females of couples, we found that the outcome of death had similar rates, but HIV+ females had higher rates of initiating ART therapy than HIV+ males. This led to the combined outcome of disease progression to be higher in HIV+ females than HIV+ males.

For HIV+ males, age, was found to be associated with HIV progression in the multivariate analysis. HIV stage and genital inflammation was found to be associated with disease progression in the univariate analysis. We did find additional associations of extrapulmonary TB and ESR with disease progression in the multivariate analysis including missingness variables, but it is unknown if these associations truly exist.

In the HIV+ females, there was an association between date of enrollment, age, HIV stage, pregnancy status, and genital inflammation. In the univariate analysis, the previous stated exposures, method of contraception and genital ulceration were also found to be associated with disease progression. There were small samples sizes for those who progressed and had high log viral load or had TB, but multivariate associations were found when including missingness variables. These associations may be questionable.

Conclusions: We need further studies to understand why males are not initiating ART as much as females are. Implant, injectables, and OCPs are safe for HIV-infected women to use to prevent pregnancy. Higher ART for pregnant women prevents mother to child transmission.

Table of Contents

Chapter 1: Literature Review

Chapter 2: Introduction, Methods, Results, and Conclusions

Chapter 3: Public Health Recommendations

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