Evaluation of impact of long-lasting insecticide-treated bed nets and point-of-use water filters on HIV-1 disease progression in Kenya.

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 long-lasting 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.