Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa.

BACKGROUND: Short-term morbidity and mortality rates for HIV positive soldiers in the South African National Defence Force (SANDF) would inform decisions about deployment and HIV disease management. Risks were determined according to the latest CD4+ cell count and use of antiretroviral therapy (ART) for HIV positive individuals in the SANDF and their dependents. METHODS AND FINDINGS: A total of 7,114 participants were enrolled and followed for mortality over a median of 4.7 years (IQR: 1.9, 7.1 years). For a planned subset (5,976), progression of disease (POD) and grade 4, potentially life-threatening events were also ascertained. CD4+ count and viral load were measured every 3 to 6 months. Poisson regression was used to compare event rates by latest CD4+ count (<50, 50-99, 100-199, 200-349, 350-499, 500+) with a focus on upper three strata, and to estimate relative risks (RRs) (ART/no ART). Median entry CD4+ was 207 cells/mm3. During follow-up over 70% were prescribed ART. Over follow-up 1,226 participants died; rates ranged from 57.6 (< 50 cells) to 0.8 (500+ cells) per 100 person years (py). Compared to those with latest CD4+ 200-349 (2.2/100 py), death rates were significantly lower (p<0.001), as expected, for those with 350-499 (0.9/100 py) and with 500+ cells (0.8/100 py). The composite outcome of death, POD or grade 4 events occurred in 2,302 participants (4,045 events); rates were similar in higher CD4+ count strata (9.4 for 350-499 and 7.9 for 500+ cells) and lower than those with counts 200-349 cells (13.5) (p<0.001). For those with latest CD4+ 350+ cells, 63% of the composite outcomes (680 of 1,074) were grade 4 events. CONCLUSION: Rates of morbidity and mortality are lowest among those with CD4+ count of 350 or higher and rates do not differ for those with counts of 350-499 versus 500+ cells. Grade 4 events are the predominant morbidity for participants with CD4+ counts of 350+ cells.

Factors Associated with Pulmonary Tuberculosis Outcomes among Inmates in Potchefstroom Prison in North West Province

Tuberculosis is the leading cause of death among the world's prison populations. Prisons are reservoirs of tuberculosis and threaten inmates; prison staff; visitors and the surrounding community. This study was carried out to explore the associated factors with pulmonary tuberculosis treatment outcomes at Potchefstroom Prison. A retrospective record review of 202 inmates with tuberculosis; whose treatment outcomes as of March 2010 were known; was conducted. Data on sex; racial group; level of education; weight; smoking habits; existence and type of co-morbidity; diagnostic classification; treatment regimen; initiation date; completion date and outcome; use of directly observed treatment; allergy and hospitalisation were captured. The majority of the inmates (142; 70.3) were aged 21-37 years; while 48 (23.8) were aged 38-53 years. There were 198 (98) male and 4 (2) female inmates. Fifty-five inmates (27.3) had attained Grade 6 and lower; 71 (35.1) grade 7-9; 68 (33.7) Grade 10-12; and 8 (3.9) above grade 12. One hundred and fifty-eight (78.2) received occasional visitors. There were 121 (59.9) smokers. The adverse outcomes for tuberculosis were significantly increased by an age 37 years; human immunodeficiency virus co-infection; smoking; a lack of support and an absence of directly observed treatment. Inmates who received fewer visits and less social support must be supported by community volunteers; counsellors and psychologists in order to motivate them and enhance favourable treatment outcomes. Smokers need to stop smoking. Younger inmates require peer support groups