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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis
Clinical Infectious Diseases, Volume 62, No. 12, Year 2016
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Description
Background. To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs). Methods. Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/μL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. Results. We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95% CI, $43.8-$49.4 million). Conclusions. There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted. © 2016 The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4885646/bin/supp_62_12_1595__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC4885646/bin/supp_ciw125_ciw125supp.docx
Authors & Co-Authors
Low, Andrea Jane
United Kingdom, London
London School of Hygiene & Tropical Medicine
United States, New York
Columbia University
Larke, Natasha L.
United Kingdom, London
Medical Research Council
Stover, John
United States, Glastonbury
Avenir Health
Muhe, Lulu Mussa
Switzerland, Geneva
Organisation Mondiale de la Santé
Easterbrook, Philippa Jane
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 107
Authors: 5
Affiliations: 6
Identifiers
Doi:
10.1093/cid/ciw125
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Systematic review