Abstract:
OBJECTIVES:
Among HIV-1-infected individuals in Africa, coinfection with malaria and diarrhoeal disease may be
associated with more rapid HIV-1 disease progression. We sought to determine whether the use of longlasting insecticide-treated bed nets and simple point-of-use water filters can delay HIV-1 disease
progression.
DESIGN:
A prospective cohort study.
SETTING:
Two HIV care sites in Kenya.
PARTICIPANTS:
HIV-1-infected adults not yet meeting criteria for antiretroviral therapy.
INTERVENTIONS:
One group received the standard of care, whereas the other received long-lasting insecticide-treated
bed nets and water filters. Individuals were followed for up to 24 months.
MAIN OUTCOME MEASURES:
The primary outcome measures were time to CD4 cell count less than 350 cells/μl and a composite
endpoint of time to CD4 cell count less than 350 cells/μl and nontraumatic death. 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. Median baseline
CD4 cell counts were similar (P=0.36). After controlling for baseline CD4 cell count, individuals receiving
the intervention were 27% less likely to reach the endpoint of a CD4 cell count less than 350 cells/μl
(hazard ratio 0.73; 95% confidence interval 0.57-0.95). CD4 cell count decline was also significantly less
in the intervention group (-54 vs. -70 cells/μl per year, P=0.03). In addition, the incidence of malaria and
diarrhoea were significantly lower in the intervention group.
CONCLUSION:
Provision of a long-lasting insecticide-treated bed net and water filter was associated with a delay in CD4
cell count decline and may be a simple, practical and cost-effective strategy to delay HIV-1 progression
in many resource-limited settings.
