We hypothesized that the median CD4 cell count at ART initiation and TB case finding over the years would have increased, and that an associated decrease in mortality would have occurred. The Adult Infectious Diseases Clinic (AIDC) at the Infectious Diseases Institute (IDI), at IWR-1 clinical trial the Makerere University College of Health Sciences in Kampala, Uganda, has provided out-patient HIV care since its inception in 2002. Treatment is based on the national guidelines of the Ugandan Ministry of Health, and consists of daily co-trimoxazole prophylaxis for all patients

irrespective of CD4 count, and ART initiation in those with a prior AIDS diagnosis (WHO stage IV disease) or a CD4 count <250 cells/μL [14, 15]. This CD4 count threshold was raised from <200 cells/μL in 2009. First-line ART comprises stavudine (d4T) or zidovudine (ZDV) in combination with lamivudine (3TC) plus a nonnucleoside reverse transcriptase inhibitor in standard doses [nevirapine (NVP) or efavirenz (EFV)]. The choice of ART is at the physician's discretion and is also dependent on availability. Screening for active opportunistic selleck chemicals llc infections including

TB takes place prior to ART initiation. Available investigations for TB include sputum microscopy, chest radiology, abdominal ultrasonography, and fine-needle lymph node aspiration for acid-fast bacilli microscopy and cytology. Diagnosis of TB is made on the basis of these investigations, but very often on presentation of symptoms only. Patients diagnosed with active TB are treated with standard WHO-recommended regimens [16]. A specialized outdoor TB/HIV clinic was set up on the IDI grounds in 2008, which centralized all TB and HIV care for both TB suspects and patients on TB treatment. Dedicated medical officers and nurse-counsellors were trained in diagnosis and management of the coinfection, and more systematic screening and follow-up were implemented. Scheduled clinic appointments take place every 4 weeks with monitoring of

clinical status and adherence. CD4 cell counts are performed every 6-phosphogluconolactonase 6 months using FACS Calibur (Becton Dickinson, Franklin Lakes, NJ, USA). Viral load monitoring is not routine and is only available for patients suspected of virological failure on clinical and immunological grounds. Patients requiring in-patient care are referred to Mulago Hospital, a tertiary care hospital in the same complex. All care at the IDI is free of charge. Data on clinical parameters, ART and adherence, WHO stage, toxicities and opportunistic infections are routinely collected into a database, to which laboratory data are added electronically. Pharmacy data on TB drug prescriptions were used to validate this database, as previously described [17].