Background Disclosure of HIV status can influence clinical outcomes. Disclosure leads to social support, improved adherence and positive living which may affect immune reconstitution. Data on the effect of disclosure on immune reconstitution is limited. The objective of this study was to assess the effect of partner disclosure at ART initiation on immune reconstitution.
Methods A retrospective cohort study was done among adults with a spouse/steady partner, initiating ART within 3 months of enrollment at Coptic Hope Center between January 2009 and June 2010. Immune reconstitution was defined as 30% increase in CD4 count (cells/mm3) following ART, and disclosure as self-reported disclosure of HIV status to spouse/steady partner at ART initiation. Data was obtained from patient records collected routinely for clinical care. The association between disclosure and immune reconstitution was assessed using Kaplan-Meier survival curve and multivariate Cox proportional hazards model adjusted for covariates univariately associated with immune reconstitution (P ≤ 0.10).
Results Among 543 clients initiating ART within 3 months of enrollment, 467 (86%) had disclosed their status to their spouses/steady partner. Median CD4 count at disclosure was 143 cells/mm3. At month 12, 68% of those who had disclosed had attained immune reconstitution compared to 48% of those who had not disclosed. By 24 months, 80% of adults in the disclosed group had reconstituted their immune status compared to 60% of those who had not disclosed. Adults with higher baseline CD4 count were less likely to attain immune reconstitution while adults who had disclosed their status to their spouse/steady partner were 63% more likely to attain immune reconstitution compared to those who had not disclosed (p < 0.05). There was a trend that higher education was associated with immune reconstitution.
Conclusions Disclosure at ART was significantly associated with immune reconstitution. HIV disclosure status may be essential in improving the clinical outcomes of clients.
- HIV KL01,