Viral load measurements are not performed routinely. Patients are initiated on ART according to Tanzanian

National AIDS Control Program (NACP) ART initiation criteria: CD4 cell count < 200 cells/μL or clinical World Health Organization (WHO) stage IV or clinical WHO stage III with a CD4 cell count of < 350 cells/μL (6). Antiretroviral drugs and cotrimoxazole are provided free of charge by the Tanzanian government. The study was approved by the Muhimbili University of Health and Allied Sciences and the Harvard School of Public Health ethical boards. Patient demographic, clinical, laboratory and therapeutic data are collected by physicians Olaparib manufacturer and nurses on standard case report forms and National Care and Treatment Centre forms at enrolment and at each follow-up visit. Demographic and anthropometric measurements, clinical examination findings, including the presence

or absence of jaundice, hepatospleenomegaly and WHO HIV clinical stage were included in this study. Laboratory data included: ALT, CD4 T-cell count, haemoglobin, HDL cholesterol, LDL cholesterol, triglycerides (TG), HBV surface antigen (HbsAg), HCV antibody and a fasting or random blood glucose. Data reviewers are stationed at each clinic to ensure adequacy and completeness of data recording by the healthcare workers. Data collected are then entered into a secure computerized database buy TSA HDAC designed solely for the purpose of data collection and analysis. Unique patient identifiers are used. The database is updated daily by professional data entry clerks. Weekly quality assurance checks of the database are performed by the data

management team to ensure data accuracy. The primary outcome of interest was elevated ALT, defined as an ALT > 40 IU/L taken between 0 and 7 days after enrolment at the HIV clinics and before ART was initiated. Statistical tests were conducted using sas version 9.1 (SAS Institute, Cary, NC) statistical software. We used mean and standard deviation (SD) for continuous variables, and proportions were used to describe the basic characteristics of the study population IMP dehydrogenase at the time of enrolment. Log-binomial regression models were used to obtain point and interval estimates of prevalence ratios for elevated ALT and to obtain P-values. Ordinal score tests were used to obtain P-values for ordinal categorical variables [20, 21]. Variables with P-values of < 0.05 were considered significant. Between November 2004 and December 2009, a total of 66,609 adult patients enrolled in the MDH programme. After exclusion of patients with missing baseline ALT values and patients on ART at baseline, 41 891 were eligible for inclusion in our analysis. Compared with the excluded patients, those who were included in this analysis had, on average, a significantly lower CD4 cell count (242 cells/μL for those included in the study vs. 297 cells/μL for those not included in the study), had a significantly higher proportion of patients in WHO HIV stage 4 (20.