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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Non-AIDS-defining events among HIV-1-infected adults receiving combination antiretroviral therapy in resource-replete versus resource-limited urban setting
AIDS, Volume 25, No. 12, Year 2011
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Description
Objective: To compare incidence and distribution of non-AIDS-defining events (NADEs) among HIV-1-infected adults receiving combination antiretroviral therapy (cART) in urban sub-Saharan African versus United States settings. Design: Retrospective cohort analysis of clinical trial and observational data. Methods: Compared crude and standardized (to US cohort by age and sex) NADE rates from two urban adult HIV-infected cART-initiating populations: a clinical trial cohort in Gaborone, Botswana (Botswana) and an observational cohort in Nashville, Tennessee (USA). Results: Crude NADE incidence rates were similar: 10.0 [95% confidence interval 6.3-15.9] per 1000 person-years in Botswana versus 12.4 [8.4-18.4] per 1000 person-years in the United States. However, after standardizing to an older, predominantly male US population, the overall NADE incidence rates were higher in Botswana [18.7 (8.3-33.1) per 1000 person-years]. Standardized rates differed most for cardiovascular events (8.4 versus 5.0 per 1000 person-years) and non-AIDS-defining malignancies (8.0 versus 0.5 per 1000 person-years)-both higher in Botswana. Conversely, hepatic NADE rates were higher in the United States (4.0 versus 0.0 per 1000 person-years), whereas renal NADE rates [3.0 per 1000 person-years (United States) versus 2.4 per 1000 person-years (Botswana)] were comparable. Conclusion: Crude NADE incidence rates were similar between cART-treated patients in a US observational cohort and a sub-Saharan African clinical trial. However, when standardized to the US cohort, overall NADE rates were higher in Botswana. NADEs appear to be a significant problem in our sub-Saharan African setting, and the monitoring, prevention, and treatment of NADEs should be a critical component of care in resource-limited settings. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Wester, Carolyn William
United States, Nashville
Vanderbilt University School of Medicine
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
United States, Nashville
Vanderbilt University Medical Center
Koethe, John Robert
United States, Nashville
Vanderbilt University School of Medicine
Shepherd, Bryan Earl
United States, Nashville
Vanderbilt University School of Medicine
Stinnette, Samuel E.
United States, Nashville
Vanderbilt University School of Medicine
Rebeiro, Peter F.
United States, Nashville
Vanderbilt University School of Medicine
Kipp, Aaron M.
United States, Nashville
Vanderbilt University School of Medicine
United States, Nashville
Vanderbilt University Medical Center
Hong, Hwanhee
United States, Boston
Harvard T.h. Chan School of Public Health
Bussmann, Hermann
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Gaolathe, Tendani
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
McGowan, Catherine Carey
United States, Nashville
Vanderbilt University School of Medicine
Sterling, Timothy R.
United States, Nashville
Vanderbilt University School of Medicine
Marlink, Richard G.
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Statistics
Citations: 64
Authors: 12
Affiliations: 4
Identifiers
Doi:
10.1097/QAD.0b013e328347f9d4
e-ISSN:
14735571
Research Areas
Infectious Diseases
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Botswana
Participants Gender
Male