Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study

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dc.contributor.authorSchutz, Charlotteen_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.contributor.authorStead, Daveen_ZA
dc.contributor.authorRebe, Kevinen_ZA
dc.contributor.authorOsler, Megen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.date.accessioned2015-11-11T12:02:39Z
dc.date.available2015-11-11T12:02:39Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: Interventions to promote prevention and earlier diagnosis of severe symptomatic hyperlactataemia (SHL) were implemented in the Western Cape provincial antiretroviral programme (South Africa) from 2004. Interventions included clinician education, point-of-care lactate meters, switch from stavudine to zidovudine in high risk patients and stavudine dose reduction. This study assessed trends in referral rate, severity at presentation and case fatality rate for severe SHL. METHODS: Retrospective study of severe SHL cases diagnosed at a referral facility from 1 January 2003 to 31 December 2008. Severe SHL was defined as patients with compatible symptoms and serum lactate [greater than or equal to] 5 mmol/l attributable to antiretroviral therapy (ART). Cumulative ART exposure at referring ART clinics was used to calculate referral rates. RESULTS: There were 254 severe SHL cases. The referral rate (per thousand patient years [py] ART exposure) peaked in 2005 (20.4/1000py), but fell to 1.3/1000py by 2008 (incidence rate ratio [IRR] = 0.07, 95%CI 0.04-0.11). In 2003, 66.7% of cases presented with a standard bicarbonate (SHCO3) level <15 mmol/l, but this fell to 12.5% by 2008 (p for trend < 0.001). Case fatality rate fell from a peak of 33.3% in 2004 to 0% in 2008 (p for trend = 0.002). CONCLUSIONS: These trends suggest the interventions were associated with reduced referral, less severe metabolic acidosis at presentation and improved survival.en_ZA
dc.identifier.apacitationSchutz, C., Boulle, A., Stead, D., Rebe, K., Osler, M., & Meintjes, G. (2010). Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study. <i>AIDS Research and Therapy</i>, http://hdl.handle.net/11427/14894en_ZA
dc.identifier.chicagocitationSchutz, Charlotte, Andrew Boulle, Dave Stead, Kevin Rebe, Meg Osler, and Graeme Meintjes "Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study." <i>AIDS Research and Therapy</i> (2010) http://hdl.handle.net/11427/14894en_ZA
dc.identifier.citationSchutz, C., Boulle, A., Stead, D., Rebe, K., Osler, M., & Meintjes, G. (2010). Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study. AIDS Research and Therapy, 7(1), 1-6.en_ZA
dc.identifier.ris TY - Journal Article AU - Schutz, Charlotte AU - Boulle, Andrew AU - Stead, Dave AU - Rebe, Kevin AU - Osler, Meg AU - Meintjes, Graeme AB - BACKGROUND: Interventions to promote prevention and earlier diagnosis of severe symptomatic hyperlactataemia (SHL) were implemented in the Western Cape provincial antiretroviral programme (South Africa) from 2004. Interventions included clinician education, point-of-care lactate meters, switch from stavudine to zidovudine in high risk patients and stavudine dose reduction. This study assessed trends in referral rate, severity at presentation and case fatality rate for severe SHL. METHODS: Retrospective study of severe SHL cases diagnosed at a referral facility from 1 January 2003 to 31 December 2008. Severe SHL was defined as patients with compatible symptoms and serum lactate [greater than or equal to] 5 mmol/l attributable to antiretroviral therapy (ART). Cumulative ART exposure at referring ART clinics was used to calculate referral rates. RESULTS: There were 254 severe SHL cases. The referral rate (per thousand patient years [py] ART exposure) peaked in 2005 (20.4/1000py), but fell to 1.3/1000py by 2008 (incidence rate ratio [IRR] = 0.07, 95%CI 0.04-0.11). In 2003, 66.7% of cases presented with a standard bicarbonate (SHCO3) level <15 mmol/l, but this fell to 12.5% by 2008 (p for trend < 0.001). Case fatality rate fell from a peak of 33.3% in 2004 to 0% in 2008 (p for trend = 0.002). CONCLUSIONS: These trends suggest the interventions were associated with reduced referral, less severe metabolic acidosis at presentation and improved survival. DA - 2010 DB - OpenUCT DO - 10.1186/1742-6405-7-13 DP - University of Cape Town J1 - AIDS Research and Therapy LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study TI - Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study UR - http://hdl.handle.net/11427/14894 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14894
dc.identifier.urihttp://dx.doi.org/10.1186/1742-6405-7-13
dc.identifier.vancouvercitationSchutz C, Boulle A, Stead D, Rebe K, Osler M, Meintjes G. Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study. AIDS Research and Therapy. 2010; http://hdl.handle.net/11427/14894.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Schutz et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceAIDS Research and Therapyen_ZA
dc.source.urihttp://www.aidsrestherapy.com/en_ZA
dc.subject.otherReferral Rateen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.titleReduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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