1–56.6). Most individual symptoms recorded during this period were also found to be associated during crude analysis with

SHLA (Table 4). The most highly associated (OR>10) were abdominal pain, poor appetite and vomiting. Cases experienced a median of 4 symptoms (IQR 1-6), while controls experienced a median of 0 symptoms (IQR 0-1) during the 80 days prior MG-132 molecular weight to their matched case diagnosis date (OR 2.0 per each additional symptom; 95% CI 1.5–2.6). Weight loss was found to be strongly associated with SHLA, with cases losing a median of 5 kg and controls losing a median of 0 kg (OR 1.4 per kg; 95% CI 1.2–1.6). The second multivariate model (Table 5, model B) characterizes associations between SHLA and data collected during follow-up consultations. Cases were at 12.6 times greater odds (95% CI 3.3–47.2) of having experienced at least one of the three major symptoms described above during the 80 days prior to case diagnosis. In comparison with controls, patients diagnosed with SHLA were at 3.4 times greater odds of having experienced peripheral neuropathy (95% CI 1.1–9.8) and 6.1 times greater odds (95% CI 2.0–18.3) of experiencing weight loss of at least 2 kg in the 3 months prior to case presentation. The last model (Table 5, model C) is an alternate model of associations between SHLA and clinical measures during follow-up based on 125 patients

with serial ALT measurements. Patients Meloxicam with an increase Thiazovivin in vitro in ALT of ≥10 U/L from the start of ART had a 3.1 times greater odds of SHLA (95% CI 1.1–8.9) in comparison with those gaining <10U/L (after adjusting for major SHLA symptoms). This study capitalizes on the cohort monitoring system in the Western Cape and one of the largest case series of SHLA

in order to provide a comprehensive analysis of the risk factors and early clinical characteristics of SHLA. It is the only in-depth SHLA study from Africa using appropriately selected controls to quantify associations. In patients treated with d4T, 3TC and nevirapine or efavirenz, female gender, a high baseline weight, and rapid early weight gain (≥6 kg) are confirmed in this study as significant risk factors for developing SHLA [6,11,13,16,17,23,24]. Previous studies have shown associations between SHLA and low baseline CD4 counts (<350 cells/μL) as well as age >40 years [16,24]. This study could not confirm either finding. With respect to CD4 counts, the study participants were a fairly homogeneous group, with 75% of the nadir CD4 counts below 155 cells/μL. Baseline age was also not found to be associated with SHLA, possibly because of the relative under-representation of older patients in the study population. Amongst ART drugs used in South Africa, only d4T at a dosage of 80 mg daily for ≥100 days was found to be a strong risk factor for SHLA in univariate analysis.