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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings
Journal of Acquired Immune Deficiency Syndromes, Volume 53, No. 1, Year 2010
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Description
OBJECTIVES: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. METHODS: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. RESULTS: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. CONCLUSIONS: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings. Copyright © 2009 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Tuboi, Suely Hiromi
Brazil, Niteroi
Universidade Federal Fluminense
Pacheco, A. G.
Brazil, Rio de Janeiro
Fundacao Oswaldo Cruz
Harrison, Lee H.
United States, Pittsburgh
University of Pittsburgh Graduate School of Public Health
Stone, Roslyn A.
United States, Pittsburgh
University of Pittsburgh Graduate School of Public Health
May, Margaret T.
United Kingdom, Bristol
University of Bristol
Brinkhof, Martin W.G.
Switzerland, Bern
University of Bern
Dabis, Franćois Ç.Ois
France, Paris
Inserm
Egger, Matthias
Switzerland, Bern
University of Bern
Nash, Denis B.
United States, New York
Mailman School of Public Health
Bangsberg, David R.
United States, Boston
Massachusetts General Hospital
Braitstein, Paula K.A.
United States, Indianapolis
Indiana University School of Medicine
Kenya, Eldoret
Moi University
United States, Indianapolis
Regenstrief Institute Inc
Yiannoutsos, Constantin Theodore
United States, Indianapolis
Indiana University School of Medicine
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Sprinz, Eduardo
Brazil, Porto Alegre
Hospital de Clinicas de Porto Alegre
Schechter, Mauro T.
Brazil, Rio de Janeiro
Universidade Federal do Rio de Janeiro
Statistics
Citations: 45
Authors: 15
Affiliations: 14
Identifiers
Doi:
10.1097/QAI.0b013e3181c22d19
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study