RESUMO
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.