WHO Stage 3 Disease Conditions and Outcomes in Patients Started on Antiretroviral Therapy in Malawi

ABSTRACT

Background: In Malawi; WHO stage 3 is the commonest reason for HIV-infected patients to be started on antiretroviral therapy (ART). The aim of the study was to document disease conditions with which patients are classified in Stage 3 and their relationship to 6-month treatment outcomes. Methodology: A retrospective survey was carried out examining ART patient treatment cards and ART registers in 6 publicsector health facilities in Southern Malawi. Results: There were 490 adult patients in Stage 3 who were started on ART; of whom 458 (93.5) were started due to one disease condition. Of these patients; symptomatic conditions (unexplained weight loss or chronic/intermittent fever for more than 1 month or chronic diarrhea for more than 1 month) were documented in 216 (47.2) patients; and active and previous tuberculosis in 148 (32.3) patients. There were no patients with oral hairy leukoplakia; severe mouth ulceration; or haematological abnormalities. At 6 months; 75of patients were alive on ART; 14were dead; 6were lost to follow-up and 4were transferred out. Adverse outcomes of death and lost to follow-up were more common in the group with a symptomatic condition (24.9) compared with the group with a specific disease condition (17.6) - OR 1.55 [95CI 0.95-2.53]. Conclusions: Nearly half the ART patients in Stage 3 started therapy due to a symptomatic condition; with outcomes inferior to those starting with a specific diagnosis. A better assessment of patients is needed so that serious; unrecognized diseases; forexample tuberculosis; are not missed before starting ART