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Shamu T, Egger M, Mudzviti T, Chimbetete C, Manasa J, Anderegg N. Virologic outcomes on dolutegravir-, atazanavir-, or efavirenz-based ART in urban Zimbabwe: A longitudinal study. PLoS One 2024; 19:e0293162. [PMID: 38394297 PMCID: PMC10890724 DOI: 10.1371/journal.pone.0293162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
There are few data from sub-Saharan Africa on the virological outcomes associated with second-line ART based on protease inhibitors or dolutegravir (DTG). We compared viral load (VL) suppression among people living with HIV (PLWH) on atazanavir (ATV/r)- or DTG-based second-line ART with PLWH on efavirenz (EFV)-based first-line ART. We analyzed data from the electronic medical records system of Newlands Clinic in Harare, Zimbabwe. We included individuals aged ≥12 years when commencing first-line EFV-based ART or switching to second-line DTG- or ATV/r-based ART with ≥24 weeks follow-up after start or switch. We computed suppression rates (HIV VL <50 copies/mL) at weeks 12, 24, 48, 72, and 96 and estimated the probability of VL suppression by treatment regimen, time since start/switch of ART, sex, age, and CD4 cell count (at start/switch) using logistic regression in a Bayesian framework. We included 7013 VL measurements of 1049 PLWH (61% female) initiating first-line ART and 1114 PLWH (58% female) switching to second-line ART. Among those switching, 872 (78.3%) were switched to ATV/r and 242 (21.7%) to DTG. VL suppression was lower in second-line ART than first-line ART, except at week 12, when those on DTG showed higher suppression than those on EFV (aOR 2.10, 95%-credible interval [CrI] 1.48-3.00) and ATV/r-based regimens (aOR 1.87, 95%-CrI 1.32-2.71). For follow-up times exceeding 24 weeks however, first-line participants demonstrated significantly higher VL suppression than second-line, with no evidence for a difference between DTG and ATV/r. Notably, from week 48 onward, VL suppression seemed to stabilize across all regimen groups, with an estimated 89.1% (95% CrI 86.9-90.9%) VL suppression in EFV, 74.5% (95%-CrI 68.0-80.7%) in DTG, and 72.9% (95%-CrI 69.5-76.1%) in ATV/r at week 48, showing little change for longer follow-up times. Virologic monitoring and adherence support remain essential even in the DTG era to prevent second-line treatment failure in settings with limited treatment options.
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Affiliation(s)
- Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe
- Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Justen Manasa
- Innovation Hub, University of Zimbabwe, Harare, Zimbabwe
| | - Nanina Anderegg
- Newlands Clinic, Harare, Zimbabwe
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
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Shamu T, Egger M, Mudzviti T, Chimbetete C, Manasa J, Anderegg N. Body weight and blood pressure changes on dolutegravir-, efavirenz- or atazanavir-based antiretroviral therapy in Zimbabwe: a longitudinal study. J Int AIDS Soc 2024; 27:e26216. [PMID: 38332525 PMCID: PMC10853595 DOI: 10.1002/jia2.26216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Dolutegravir (DTG) is widely used for antiretroviral therapy (ART). We compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG-based, efavirenz (EFV)-based and ritonavir-boosted atazanavir (ATV/r)-based ART in Zimbabwe. METHODS PLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r-based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible. Weight was measured at all visits (Seca floor scales); blood pressure only at clinician-led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen. Finally, we examined whether trends in the proportion with high blood pressure were related to weight change. RESULTS We analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88-5.28 kg) in women and 3.71 kg (3.07-4.45 kg) in men, around twice that observed for ATV/r and over four-times the gain observed for EFV. Prevalence of high blood pressure among PLHIV receiving DTG-based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV- or ATV/r-based ART. High blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains. CONCLUSIONS Among PLHIV starting ART or switching to a new regimen, DTG-based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure. Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG-based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG.
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Affiliation(s)
- Tinei Shamu
- Newlands ClinicHarareZimbabwe
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Graduate School of Health SciencesUniversity of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Tinashe Mudzviti
- Newlands ClinicHarareZimbabwe
- Department of Pharmacy and Pharmaceutical SciencesUniversity of ZimbabweHarareZimbabwe
| | | | | | - Nanina Anderegg
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
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Hunter-Dickson M, Drak D, Anderson M, Shamu T, Chimbetete C, Dahwa R, Gracey DM. Comparison of CG, CKD-EPI[AS] and CKD-EPI[ASR] equations to estimate glomerular filtration rate and predict mortality in treatment naïve people living with HIV in Zimbabwe. BMC Nephrol 2023; 24:129. [PMID: 37158821 PMCID: PMC10169375 DOI: 10.1186/s12882-023-03159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/09/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Renal impairment in people living with HIV (PWH) in Sub-Saharan Africa is common and associated with increased morbidity and mortality. The ideal equation to estimate glomerular filtration rate (eGFR) in this population remains unclear. That which best predicts clinical risk may be the most appropriate while validation studies are awaited. Here we compare the Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI[ASR]) and the CKD-EPI equation with the race coefficient removed (CKD-EPI[AS]), in a population of anti-retroviral therapy (ART) naïve PWH in Zimbabwe to assess which equation best predicts mortality. METHODS A retrospective cohort study of treatment naïve PWH at the Newlands Clinic in Harare, Zimbabwe was completed. The study included all patients commencing ART between 2007 and 2019. Predictors of mortality were assessed by multivariable logistic regression. RESULTS A total of 2991 patients were followed-up for a median of 4.6 years. The cohort was 62.1% female, with 26.1% of patients having at least one comorbidity. The CG equation identified 21.6% of patients as having renal impairment compared with 17.6% with CKD-EPI[AS] and 9.3% with CKD-EPI[ASR]. There was a mortality rate of 9.1% across the study period. The highest mortality risk was seen in those with renal impairment as determined by the CKD-EPI[ASR] equation for both eGFR < 90 and eGFR < 60 with OR 2.97 (95%CI 1.86-4.76) and OR 10.6 (95%CI 3.15-18.04) respectively. CONCLUSION In treatment naïve PWH in Zimbabwe, the CKD-EPI[ASR] equation identifies patients at highest risk of mortality when compared to the CKD-EPI[AS] and CG equations.
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Affiliation(s)
| | - Douglas Drak
- Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Matthew Anderson
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | | | | | - Rumbidzai Dahwa
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - David M Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
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Magodoro I, Guerrero-Chálela CE, Claggett B, Samuels P, Jermy S, Naik K, Chimbetete C, Danaei G, Zar H, Ntusi N, Ntsekhe M, Siedner M. ADIPOSITY PHENOTYPES AND THEIR ASSOCIATION WITH CARDIAC REMODELING IN A COHORT OF ADOLESCENTS WITH AND WITHOUT PERINATALLY ACQUIRED HIV INFECTION IN CAPE TOWN, SOUTH AFRICA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Chihota BV, Mandiriri A, Shamu T, Muula G, Nyamutowa H, Taderera C, Mwamba D, Chilengi R, Bolton‐Moore C, Bosomprah S, Egger M, Chimbetete C, Wandeler G. Metabolic syndrome among treatment-naïve people living with and without HIV in Zambia and Zimbabwe: a cross-sectional analysis. J Int AIDS Soc 2022; 25:e26047. [PMID: 36522287 PMCID: PMC9755006 DOI: 10.1002/jia2.26047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic viral replication has been linked to an increased risk of cardiovascular and metabolic diseases in people living with HIV (PLWH), but few studies have evaluated this association in Southern Africa. We explored the determinants of metabolic syndrome (MetS) among treatment-naïve adults living with and without HIV in Southern Africa. METHODS Treatment-naïve PLWH and people living without HIV (PLWOH) ≥30 years were consecutively enrolled from primary care clinics in Zambia and Zimbabwe. PLWOH were seronegative partners or persons presenting for HIV testing. We defined MetS as the presence of central obesity plus any two of the following: raised blood pressure, impaired fasting glucose, reduced high-density lipoprotein cholesterol and raised triglycerides, as defined by the International Diabetes Federation. We used logistic regression to determine factors associated with MetS. RESULTS Between August 2019 and March 2022, we screened 1285 adults and enrolled 420 (47%) PLWH and 481 (53%) PLWOH. The median age was similar between PLWH and PLWOH (40 vs. 38 years, p < 0.24). In PLWH, the median CD4+ count was 228 cells/mm3 (IQR 108-412) and the viral load was 24,114 copies/ml (IQR 277-214,271). Central obesity was present in 365/523 (70%) females and 57/378 males (15%). MetS was diagnosed in 172/901 (19%, 95% confidence interval [CI] 17-22%), and prevalence was higher among females than males (27% vs. 9%). In multivariable analyses, HIV status was not associated with MetS (adjusted odds ratio [aOR] 1.05, 95% CI 0.74-1.51). Risk factors for MetS included age older than 50 years (aOR 2.31, 95% CI 1.49-3.59), female sex (aOR 3.47, 95% CI 2.15-5.60), highest income (aOR 2.19, 95% CI 1.39-3.44) and less than World Health Organization recommended weekly physical activity (aOR 3.35, 95% CI 1.41-7.96). CONCLUSIONS We report a high prevalence of MetS and central obesity among females in urban Zambia and Zimbabwe. Lifestyle factors and older age appear to be the strongest predictors of MetS in our population, with no evident difference in MetS prevalence between treatment-naïve PLWH and PLWOH.
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Affiliation(s)
- Belinda V. Chihota
- Centre for Infectious Disease ResearchLusakaZambia,Graduate School of Health SciencesUniversity of BernBernSwitzerland,Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | | | - Tinei Shamu
- Graduate School of Health SciencesUniversity of BernBernSwitzerland,Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Newlands ClinicHarareZimbabwe
| | - Guy Muula
- Centre for Infectious Disease ResearchLusakaZambia
| | | | | | | | | | - Carolyn Bolton‐Moore
- Centre for Infectious Disease ResearchLusakaZambia,Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Samuel Bosomprah
- Centre for Infectious Disease ResearchLusakaZambia,Department of BiostatisticsSchool of Public HealthUniversity of GhanaAccraGhana
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa,Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
| | | | - Gilles Wandeler
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
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Romo ML, Brazier E, Mahambou‐Nsondé D, De Waal R, Sekaggya‐Wiltshire C, Chimbetete C, Muyindike WR, Murenzi G, Kunzekwenyika C, Tiendrebeogo T, Muhairwe JA, Lelo P, Dzudie A, Twizere C, Rafael I, Ezechi OC, Diero L, Yotebieng M, Fenner L, Wools‐Kaloustian KK, Shah NS, Nash D. Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa. J Int AIDS Soc 2022; 25:e25961. [PMID: 35848120 PMCID: PMC9289708 DOI: 10.1002/jia2.25961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/23/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Dolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co-infection, its use is complicated by a drug-drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug-drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co-infection receiving dolutegravir or efavirenz. METHODS Within the four sub-Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015-2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months. RESULTS In the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice-daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice-daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3-63.3%), switching ART regimen was 4.1% (95% CI: 2.6-6.2%) and loss to program/death was 23.4% (95% CI: 19.7-27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28-1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08-1.51). CONCLUSIONS At a programmatic level, dolutegravir was being widely prescribed in sub-Saharan Africa for people with HIV and tuberculosis co-infection with a dose adjustment for the drug-drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.
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Affiliation(s)
- Matthew L. Romo
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population HealthCUNY Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | - Ellen Brazier
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population HealthCUNY Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | | | - Reneé De Waal
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | | | | | - Winnie R. Muyindike
- Department of Internal MedicineFaculty of MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Gad Murenzi
- Research for Development (RD Rwanda) and Rwanda Military HospitalKigaliRwanda
| | | | - Thierry Tiendrebeogo
- University of BordeauxInsermFrench National Research Institute for Sustainable Development (IRD)Bordeaux Population Health Research CenterBordeauxFrance
| | | | - Patricia Lelo
- Kalembelembe Pediatric HospitalKinshasaDemocratic Republic of the Congo
| | - Anastase Dzudie
- Clinical Research Education Networking and ConsultancyYaoundéCameroon
| | - Christelle Twizere
- Centre National de Référence en matière de VIH/SIDA (CNR)BujumburaBurundi
| | | | - Oliver C. Ezechi
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Lameck Diero
- School of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Marcel Yotebieng
- Department of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Lukas Fenner
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | | | - N. Sarita Shah
- Division of Infectious DiseasesEmory University School of Medicine & Emory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Denis Nash
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population HealthCUNY Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
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Botero-Mesa S, Coelho FC, Nwosu K, Wicht B, Venkatasubramanian A, Wagner O, Valera C, Nguimbis B, Câmara D, Reis I, Bianchi L, Mahdiani M, Onsimbie PA, Diallo PAN, Jacques L, Muloliwa AM, Bougma M, Mukavhi L, Kaneria A, Peruvemba R, Gupta A, Triulzi I, James A, Carrara V, Ngambi W, Habibi Z, Adhanom MT, Rodriguez Velásquez S, Sestito P, Kousil T, Biru L, Vivacqua D, Dalal J, Mian A, Roelens M, Orel E, Hofer CB, Wangara F, Mboussou F, Mlanda T, Bukhari A, Lee TMH, Ngom R, Stoll B, Chimbetete C, Abbate J, Impouma B, Keiser O. Leveraging human resources for outbreak analysis: lessons from an international collaboration to support the sub-Saharan African COVID-19 response. BMC Public Health 2022; 22:1073. [PMID: 35641949 PMCID: PMC9152815 DOI: 10.1186/s12889-022-13327-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Emerging infectious diseases are a growing threat in sub-Saharan African countries, but the human and technical capacity to quickly respond to outbreaks remains limited. Here, we describe the experience and lessons learned from a joint project with the WHO Regional Office for Africa (WHO AFRO) to support the sub-Saharan African COVID-19 response.In June 2020, WHO AFRO contracted a number of consultants to reinforce the COVID-19 response in member states by providing actionable epidemiological analysis. Given the urgency of the situation and the magnitude of work required, we recruited a worldwide network of field experts, academics and students in the areas of public health, data science and social science to support the effort. Most analyses were performed on a merged line list of COVID-19 cases using a reverse engineering model (line listing built using data extracted from national situation reports shared by countries with the Regional Office for Africa as per the IHR (2005) obligations). The data analysis platform The Renku Project ( https://renkulab.io ) provided secure data storage and permitted collaborative coding.Over a period of 6 months, 63 contributors from 32 nations (including 17 African countries) participated in the project. A total of 45 in-depth country-specific epidemiological reports and data quality reports were prepared for 28 countries. Spatial transmission and mortality risk indices were developed for 23 countries. Text and video-based training modules were developed to integrate and mentor new members. The team also began to develop EpiGraph Hub, a web application that automates the generation of reports similar to those we created, and includes more advanced data analyses features (e.g. mathematical models, geospatial analyses) to deliver real-time, actionable results to decision-makers.Within a short period, we implemented a global collaborative approach to health data management and analyses to advance national responses to health emergencies and outbreaks. The interdisciplinary team, the hands-on training and mentoring, and the participation of local researchers were key to the success of this initiative.
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Affiliation(s)
- Sara Botero-Mesa
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Flavio Codeço Coelho
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- School of Applied Mathematics, Getulio Vargas Foundation, Rio de Janeiro, Brazil
| | - Kenechukwu Nwosu
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Bertil Wicht
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Faculté de Lettres, University of Lausanne, Lausanne, Switzerland
| | - Akarsh Venkatasubramanian
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Institute for Technology and Global Health, Massachusetts Institute of Technology’, Cambridge, USA
- Transform Health Coalition, Geneva, Switzerland
| | - Olena Wagner
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Camille Valera
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Benedict Nguimbis
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Data analysis, The GRAPH Network, Douala, Cameroon
| | - Daniel Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Brasil - LATHEMA/IOC/FIOCRUZ, Rio de Janeiro, Brazil
- Núcleo Operacional Sentinela de Mosquitos Vetores, Fundação Oswaldo Cruz, Brasil - NOSMOVE/FIOCRUZ, Rio de Janeiro, Brazil
| | - Izabel Reis
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Brasil - LATHEMA/IOC/FIOCRUZ, Rio de Janeiro, Brazil
- Núcleo Operacional Sentinela de Mosquitos Vetores, Fundação Oswaldo Cruz, Brasil - NOSMOVE/FIOCRUZ, Rio de Janeiro, Brazil
| | - Lucas Bianchi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Sergio Arouca National School of Public Health, Fundação Oswaldo Cruz, Brasil - ENSP/FIOCRUZ, Rio de Janeiro, Brazil
| | - Morteza Mahdiani
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Papy Ansobi Onsimbie
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Research and Training Unit in Ecology and Control of Infectious Diseases (URF-ECMI), Faculty of Medicine, University of Kinshasa, Kinshasa, Congo
| | - Papa Amadou Niang Diallo
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- National Aids Committe, Fann Hospital Center, Dakar, Senegal
| | - Léa Jacques
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Artur Manuel Muloliwa
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Faculdade de Ciências da Saúde, Universidade Lúrio, Nampula, Moçambique
| | - Moussa Bougma
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Leckson Mukavhi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Adit Kaneria
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- School of Information Studies, Syracuse University, Syracuse, NY USA
| | - Ram Peruvemba
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- HSR.health, Rockville, MD USA
| | - Ajay Gupta
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- HSR.health, Rockville, MD USA
| | - Isotta Triulzi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Ananthu James
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Verena Carrara
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wingston Ngambi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Health Economics Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Zahra Habibi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Michael Tedros Adhanom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Sabina Rodriguez Velásquez
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Paolo Sestito
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Timokleia Kousil
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Loza Biru
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Pediatric Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Anatole Mian
- Data analysis, The GRAPH Network, Abidjan, Ivory Coast
| | - Maroussia Roelens
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Erol Orel
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fatihiyya Wangara
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Health Services, County Government of Kwale, Kwale, Kenya
| | - Franck Mboussou
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Tamayi Mlanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Arish Bukhari
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Roland Ngom
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Beat Stoll
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Association Actions en Santé Publique, Geneva, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Newlands Clinic, Harare, Zimbabwe
| | - Jessica Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- UMI TransVIHMI (Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier), Montpellier, France
- Geomatys, Montpellier, France
| | - Benido Impouma
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
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8
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Byers BW, Drak D, Shamu T, Chimbetete C, Dahwa R, Gracey DM. Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study. AIDS Res Ther 2022; 19:23. [PMID: 35643492 PMCID: PMC9148446 DOI: 10.1186/s12981-022-00445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background People living with HIV (PLWHIV) commencing antiretroviral therapy (ART) in sub-Saharan Africa experience significant mortality within the first year. Previously, identified risk factors for mortality may be biased towards these patients, as compared to those who experience late mortality. Aim To compare risk factors for early and late mortality in PLWHIV commencing ART. Methods A retrospective cohort study of ART-naïve patients aged ≥ 18 years from an outpatient HIV clinic in Zimbabwe. Data were collected between January 2010 and January 2019. Predictors for early (≤ 1 year) and late mortality (> 1 year) were determined by multivariable cox proportional hazards analyses, with patients censored at 1 year and landmark analysis after 1 year, respectively. Results Three thousand and thirty-nine PLWHIV were included in the analysis. Over a median follow-up of 4.6 years (IQR 2.5–6.9), there was a mortality rate of 8.8%, with 50.4% of deaths occurring within 1 year. Predictors of early mortality included CD4 count < 50 cells/µL (HR 1.84, 95% CI 1.24–2.72, p < 0.01), WHO Stage III (HR 2.05, 95% CI 1.28–3.27, p < 0.01) or IV (HR 2.83, 95% CI 1.67–4.81, p < 0.01), and eGFR < 90 mL/min/1.73 m2 (HR 2.48, 95% CI 1.56–3.96, p < 0.01). Other than age (p < 0.01), only proteinuria (HR 2.12, 95% CI 1.12–4.01, p = 0.02) and diabetes mellitus (HR 3.51, 95% CI 1.32–9.32, p = 0.01) were associated with increased risk of late mortality. Conclusions
Traditional markers of mortality risk in patients commencing ART appear to be limited to early mortality. Proteinuria and diabetes are some of the few predictors of late mortality, and should be incorporated into routine screening of patients commencing ART.
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9
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James A, Dalal J, Kousi T, Vivacqua D, Câmara DCP, Dos Reis IC, Botero Mesa S, Ng'ambi W, Ansobi P, Bianchi LM, Lee TM, Ogundiran O, Stoll B, Chimbetete C, Mboussou F, Impouma B, Hofer CB, Coelho FC, Keiser O, Abbate JL. An in-depth statistical analysis of the COVID-19 pandemic's initial spread in the WHO African region. BMJ Glob Health 2022; 7:bmjgh-2021-007295. [PMID: 35418411 PMCID: PMC9013786 DOI: 10.1136/bmjgh-2021-007295] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.
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Affiliation(s)
- Ananthu James
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, Karnataka, India .,The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland
| | - Timokleia Kousi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Cardoso Portela Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Laboratório de Mosquitos Transmissores de Hematozoários (LATHEMA), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Izabel Cristina Dos Reis
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Laboratório de Mosquitos Transmissores de Hematozoários (LATHEMA), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sara Botero Mesa
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Wignston Ng'ambi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Health Economics Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Papy Ansobi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Research and Training Unit in Ecology and Control of Infectious Diseases (URF-ECMI), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lucas M Bianchi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,World Health Organization Regional Office for Africa, Brazzaville, Congo.,National School of Public Health Sérgio Arouca, ENSP/Fiocruz, Rio de Janeiro, Brazil
| | - Theresa M Lee
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Beat Stoll
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Newlands Clinic, Harare, Zimbabwe
| | - Franck Mboussou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio Codeço Coelho
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,School of Applied Mathematics, Getulio Vargas Foundation, Rio de Janeiro, Brazil
| | - Olivia Keiser
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jessica Lee Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,World Health Organization Regional Office for Africa, Brazzaville, Congo.,UMI TransVIHMI (Institut de Recherche pour le Développement Institut National de la Santé et de la Recherche Médicale Université de Montpellier), Montpellier, France.,Geomatys, Montpellier, France
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10
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Drak D, Heron JE, Shamu T, Chimbetete C, Dahwa R, Gracey DM. Predictors of renal impairment and proteinuria after commencement of antiretroviral therapy in a Zimbabwean HIV cohort. HIV Med 2022; 23:1002-1006. [PMID: 35394105 DOI: 10.1111/hiv.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal disease prevalence varies widely amongst reported cohorts of people living with HIV (PLWHIV) in sub-Saharan Africa. Renal function testing is not routine in those commencing antiretroviral therapy (ART) in the region, however. Further data on renal disease prevalence and the change associated with ART use are therefore needed. AIM To explore changes in renal function and associated predictors after 1 year of ART in an adult cohort of PLWHIV from Zimbabwe. METHODS A retrospective analysis of patients who attended the Newlands Clinic between January 2007 and September 2019. Eligible patients were aged ≥18 years and had measures of serum creatinine at baseline and after 1 year of ART. Predictors of renal function change were assessed by multiple linear regression. RESULTS 1729 patients were eligible for inclusion. Median age was 36 years (IQR 30-43) and 62.8% were female. After 1 year of ART, the proportion of patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.732 did not significantly change (2.0% vs. 1.2%; p = 0.094), but there was a decrease in the proportion of patients with proteinuria (11.0% vs. 5.6%; p < 0.001). Hypertension (B = -6.43; 95% CI -8.97 to -3.89; p < 0.001) and baseline proteinuria (B = -7.33; 95% CI -10.25 to -4.42; p < 0.001) were negative predictors of change in eGFR from baseline, whereas diabetes status was not associated (p = 0.476). CONCLUSION Proteinuria was common, but its prevalence halved after 1 year of ART. Screening for hypertension could be a simple way to identify patients at risk of renal function decline.
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Affiliation(s)
- Douglas Drak
- Royal North Shore Hospital, St Leonards, NSW, Australia.,Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Jack E Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | | | - Rumbi Dahwa
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - David M Gracey
- Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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11
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Drak D, Shamu T, Heron JE, Chimbetete C, Dahwa R, Gracey DM. Renal function and associated mortality risk in adults commencing HIV antiretroviral therapy in Zimbabwe. AIDS 2022; 36:631-636. [PMID: 34923518 DOI: 10.1097/qad.0000000000003153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with HIV (PWH) in sub-Saharan Africa appear to have a higher incidence of renal disease than other global regions but data are limited. This renal impairment may be associated with an increased mortality risk. AIMS To define the prevalence of renal disease and explore its association with mortality risk in a cohort from Zimbabwe commencing antiretroviral therapy (ART) for HIV infection. METHODS A retrospective study of all patients aged at least 18 years, commenced on ART for HIV infection at the Newlands Clinic in Harare, Zimbabwe between January 2007 and September 2019 was conducted. Data were extracted from electronic medical records. Patients with no baseline creatinine measurement were excluded. Baseline characteristics were assessed as potential predictors for mortality by Cox proportional hazard regression. RESULTS Three thousand and thirty-nine patients were eligible for inclusion. Most were female (62.1%), with a median age of 36 years (IQR 30-43). At baseline, 7.3% had an estimated glomerular filtration rate (eGFR) 90 ml/min per 1.73 m2 or less and 11.4% had proteinuria. Over a median follow-up period of 4.6 years (IQR 2.5-6.9), the mortality rate was 8.7%. One half of deaths (49.2%) occurred within the first year. In multivariable analysis, a baseline eGFR between 60 and 90 ml/min per 1.73 m2 [hazard ratio 2.22, 95% confidence interval (CI) 1.46-3.33, P < 0.001] and proteinuria (hazard ratio 2.10, 95% CI 1.35-3.27, P < 0.001) were associated with increased mortality risk. CONCLUSION Baseline renal impairment was common. Both a reduced eGFR or proteinuria were independently associated with a doubling of mortality risk. These should serve as markers in the clinical setting of at-risk patients.
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Affiliation(s)
- Douglas Drak
- Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Tinei Shamu
- Newlands Clinic, Newlands, Harare, Zimbabwe
- Institute of Social and Preventive Medicine
- Graduate School of Health Sciences, University of Bern, Switzerland
| | - Jack E Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Rumbi Dahwa
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - David M Gracey
- Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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12
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Kousi T, Vivacqua D, Dalal J, James A, Câmara DCP, Botero Mesa S, Chimbetete C, Impouma B, Williams GS, Mboussou F, Mlanda T, Bukhari A, Keiser O, Abbate JL, Hofer CB. COVID-19 pandemic in Africa’s island nations during the first 9 months: a descriptive study of variation in patterns of infection, severe disease, and response measures. BMJ Glob Health 2022; 7:bmjgh-2021-006821. [PMID: 35277427 PMCID: PMC8919133 DOI: 10.1136/bmjgh-2021-006821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
The geographic and economic characteristics unique to island nations create a different set of conditions for, and responses to, the spread of a pandemic compared with those of mainland countries. Here, we aimed to describe the initial period of the COVID-19 pandemic, along with the potential conditions and responses affecting variation in the burden of infections and severe disease burden, across the six island nations of the WHO’s Africa region: Cabo Verde, Comoros, Madagascar, Mauritius, São Tomé e Príncipe and Seychelles. We analysed the publicly available COVID-19 data on confirmed cases and deaths from the beginning of the pandemic through 29 November 2020. To understand variation in the course of the pandemic in these nations, we explored differences in their economic statuses, healthcare expenditures and facilities, age and sex distributions, leading health risk factors, densities of the overall and urban populations and the main industries in these countries. We also reviewed the non-pharmaceutical response measures implemented nationally. We found that the burden of SARS-CoV-2 infection was reduced by strict early limitations on movement and biased towards nations where detection capacity was higher, while the burden of severe COVID-19 was skewed towards countries that invested less in healthcare and those that had older populations and greater prevalence of key underlying health risk factors. These findings highlight the need for Africa’s island nations to invest more in healthcare and in local testing capacity to reduce the need for reliance on border closures that have dire consequences for their economies.
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Affiliation(s)
- Timokleia Kousi
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- HACE: Data Changing Child Labor, Manchester, UK
| | - Ananthu James
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Daniel Cardoso Portela Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Sara Botero Mesa
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Newlands Clinic, Harare, Zimbabwe
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Franck Mboussou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tamayi Mlanda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Arish Bukhari
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olivia Keiser
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Jessica Lee Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- World Health Organization Regional Office for Africa, Brazzaville, Congo
- Geomatys, Montpellier, France
- UMI TransVIHMI (Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier), Montpellier, France
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Taghavi K, Mandiriri A, Shamu T, Rohner E, Bütikofer L, Asangbeh S, Magure T, Chimbetete C, Egger M, Pascoe M, Bohlius J. Cervical Cancer Screening Cascade for women living with HIV: a cohort study from Zimbabwe. PLOS Glob Public Health 2022; 2:e0000156. [PMID: 36860760 PMCID: PMC9974171 DOI: 10.1371/journal.pgph.0000156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Countries with high HIV prevalence, predominantly in sub-Sahahran Africa, have the highest cervical cancer rates globally. HIV care cascades successfully facilitated the scale-up of antiretroviral therapy. A cascade approach could similarly succeed to scale-up cervical cancer screening, supporting WHO's goal to eliminate cervical cancer. We defined a Cervical Cancer Screening Cascade for women living with HIV (WLHIV), evaluating the continuum of cervical cancer screening integrated into an HIV clinic in Zimbabwe. We included WLHIV aged ≥18 years enrolled at Newlands Clinic in Harare from June 2012-2017 and followed them until June 2018. We used a cascade approach to evaluate the full continuum of secondary prevention from screening to treatment of pre-cancer and follow-up. We report percentages, median time to reach cascade stages, and cumulative incidence at two years with 95% confidence intervals (CI). We used univariable Cox proportional hazard regressions to calculate cause-specific hazard ratios with 95% CIs for factors associated with completing the cascade stages. We included 1624 WLHIV in the study. The cumulative incidence of cervical screening was 85.4% (95% CI 83.5-87.1) at two years. Among the 396 WLHIV who received screen-positive tests in the study, the cumulative incidence of treatment after a positive screening test was 79.5% (95% CI 75.1-83.2) at two years. The cumulative incidence of testing negative at re-screening after treatment was 36.1% (95% CI 31.2-40.7) at two years. Using a cascade approach to evaluate the full continuum of cervical cancer screening, we found less-than 80% of WLHIV received treatment after screen-positive tests and less-than 40% were screen-negative at follow-up. Interventions to improve linkage to treatment for screen-positive WLHIV and studies to understand the clinical significance of screen-positive tests at follow-up among WLHIV are needed. These gaps in the continuum of care must be addressed in order to prevent cervical cancer.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Tinei Shamu
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Newlands Clinic, Harare, Zimbabwe
- The Graduate School for Health Sciences of the University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Serra Asangbeh
- The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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14
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Shamu T, Rohner E, Chokunonga E, Spoerri A, Mandiriri A, Chimbetete C, Egger M, Bohlius J, Borok M. Cancer incidence among people living with HIV in Zimbabwe: A record linkage study. Cancer Rep (Hoboken) 2021; 5:e1597. [PMID: 34873875 PMCID: PMC9575496 DOI: 10.1002/cnr2.1597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 11/11/2022] Open
Abstract
Background People living with HIV (PLWH) are at increased risk of developing cancer. Cancer diagnoses are often incompletely captured at antiretroviral therapy (ART) clinics. Aim To estimate the incidence and explore risk factors of cancer in a cohort of PLWH in Harare using probabilistic record linkage (PRL). Methods We conducted a retrospective cohort study that included PLWH aged ≥16 years starting ART between 2004 and 2017. We used PRL to match records from the Zimbabwe National Cancer Registry (ZNCR) with electronic medical records from an ART clinic in Harare to investigate the incidence of cancer among PLWH initiating ART. We matched records based on demographic data followed by manual clerical review. We followed PLWH up until first cancer diagnosis, death, loss to follow‐up, or 31 December 2017, whichever came first. Results We included 3442 PLWH (64.9% female) with 19 346 person‐years (PY) of follow‐up. Median CD4 count at ART initiation was 169 cells/mm3 (interquartile range [IQR]: 82–275), median age was 36.6 years (IQR: 30.6–43.4). There were 66 incident cancer cases for an overall incidence rate of 341/100 000 PY (95% confidence interval [CI]: 268–434). Twenty‐two of these cases were recorded in the ZNCR only. The most common cancers were cervical cancer (n = 16; 123/100 000 PY; 95% CI: 75–201), Kaposi sarcoma, and lymphoma (both n = 12; 62/100 000 PY; 95% CI: 35–109). Cancer incidence increased with age and decreased with higher CD4 cell counts at ART initiation. Conclusion PRL was key to correct for cancer under‐ascertainment in this cohort. The most common cancers were infection‐related types, reinforcing the role of early HIV treatment, human papillomavirus vaccination, and cervical cancer screening for cancer prevention in this setting.
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Affiliation(s)
- Tinei Shamu
- Newlands Clinic, Newlands, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Margaret Borok
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe.,Unit of Internal Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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15
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Rodriguez Velásquez S, Jacques L, Dalal J, Sestito P, Habibi Z, Venkatasubramanian A, Nguimbis B, Mesa SB, Chimbetete C, Keiser O, Impouma B, Mboussou F, William GS, Ngoy N, Talisuna A, Gueye AS, Hofer CB, Cabore JW. The toll of COVID-19 on African children: A descriptive analysis on COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa. Int J Infect Dis 2021; 110:457-465. [PMID: 34332088 PMCID: PMC8457828 DOI: 10.1016/j.ijid.2021.07.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Few data on the COVID-19 epidemiological characteristics among the pediatric population in Africa exists. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population in 15 Sub-Saharan African countries. Methods A merge line listing dataset shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March and 1 September 2020 with a confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children's data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases, its medians, and 95% confidence intervals were calculated. Results 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. Adults had a higher case incidence per 100,000 people than children. Conclusion The cases and deaths within the children's population were smaller than the adult population. These differences may reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.
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Affiliation(s)
| | - Léa Jacques
- Institute of Global Health, University of Geneva, 9 chemin des Mines, 1202 Geneva, Switzerland.
| | - Jyoti Dalal
- International Labour Organization, United Nations, C/O Ochsner & Associés, Place de Longemalle 1, 1204 Geneva, Switzerland.
| | - Paolo Sestito
- Institute of Global Health, University of Geneva, 9 chemin des Mines, 1202 Geneva, Switzerland.
| | - Zahra Habibi
- Institute of Global Health, University of Geneva, 9 chemin des Mines, 1202 Geneva, Switzerland
| | - Akarsh Venkatasubramanian
- International Labour Organization, United Nations, C/O Ochsner & Associés, Place de Longemalle 1, 1204 Geneva, Switzerland.
| | - Benedict Nguimbis
- ASP/ GRAPH Network, C/O Ochsner & Associés, Place de Longemalle 1, 1204 Geneva, Switzerland.
| | - Sara Botero Mesa
- Institute of Global Health, University of Geneva, 9 chemin des Mines, 1202 Geneva, Switzerland.
| | | | - Olivia Keiser
- Institute of Global Health, University of Geneva, 9 chemin des Mines, 1202 Geneva, Switzerland.
| | - Benido Impouma
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - Franck Mboussou
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - George Sie William
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - Nsenga Ngoy
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - Ambrose Talisuna
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - Abdou Salam Gueye
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
| | - Cristina Barroso Hofer
- Department of Infectious Diseases, Universidade Federal do Rio de Janeiro, R Bruno Lobo, 50 Ilha do Fundão, Rio de Janeiro, Brazil.
| | - Joseph Waogodo Cabore
- WHO Regional Office for Africa, Epidemic Preparedness and Response Programme, Cité du Djoué, P.O. Box 06, Brazzaville, Republic du Congo.
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16
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Shamu T, Chimbetete C, Egger M, Mudzviti T. Treatment outcomes in HIV infected patients older than 50 years attending an HIV clinic in Harare, Zimbabwe: A cohort study. PLoS One 2021; 16:e0253000. [PMID: 34106989 PMCID: PMC8189507 DOI: 10.1371/journal.pone.0253000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/26/2021] [Indexed: 11/27/2022] Open
Abstract
There is a growing number of older people living with HIV (OPLHIV). While a significant proportion of this population are adults growing into old age with HIV, there are also new infections among OPLHIV. There is a lack of data describing the outcomes of OPLHIV who commenced antiretroviral therapy (ART) after the age of 50 years in sub-Saharan Africa. We conducted a cohort study of patients who enrolled in care at Newlands Clinic in Harare, Zimbabwe, at ages ≥50 years between February 2004 and March 2020. We examined demographic characteristics, attrition, viral suppression, immunological and clinical outcomes. Specifically, we described prevalent and incident HIV-related communicable and non-communicable comorbidities. We calculated frequencies, medians, interquartile ranges (IQR), and proportions; and used Cox proportional hazards models to identify risk factors associated with death. We included 420 (57% female) who commenced ART and were followed up for a median of 5.6 years (IQR 2.4–9.9). Most of the men were married (n = 152/179, 85%) whereas women were mostly widowed (n = 125/241, 51.9%). Forty per cent (n = 167) had WHO stage 3 or 4 conditions at ART baseline. Hypertension prevalence was 15% (n = 61) at baseline, and a further 27% (n = 112) had incident hypertension during follow-up. During follow-up, 300 (71%) were retained in care, 88 (21%) died, 17 (4%) were lost to follow-up, and 15 (4%) were transferred out. Of those in care, 283 (94%) had viral loads <50 copies/ml, and 10 had viral loads >1000 copies/ml. Seven patients (1.7%) were switched to second line ART during follow-up and none were switched to third-line. Higher baseline CD4 T-cell counts were protective against mortality (p = 0.001) while male sex (aHR: 2.29, 95%CI: 1.21–4.33), being unmarried (aHR: 2.06, 95%CI: 1.13–3.78), and being unemployed (aHR: 2.01, 95%CI: 1.2–3.37) were independent independent risk factors of mortality. There was high retention in care and virologic suppression in this cohort of OPLHIV. Hypertension was a common comorbidity. Being unmarried or unemployed were significant predictors of mortality highlighting the importance of sociologic factors among OPLHIV, while better immune competence at ART commencement was protective against mortality.
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Affiliation(s)
- Tinei Shamu
- Newlands Clinic, Newlands, Harare, Zimbabwe
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tinashe Mudzviti
- Newlands Clinic, Newlands, Harare, Zimbabwe
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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17
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Ballif M, Christ B, Anderegg N, Chammartin F, Muhairwe J, Jefferys L, Hector J, van Dijk J, Vinikoor MJ, van Lettow M, Chimbetete C, Phiri SJ, Onoya D, Fox MP, Egger M. Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries. Clin Infect Dis 2021; 74:171-179. [PMID: 33993219 DOI: 10.1093/cid/ciab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa. METHODS We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting. RESULTS Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites. CONCLUSIONS Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.
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Affiliation(s)
- Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Benedikt Christ
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Department of Epidemiology and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Research and Epidemiology, University of Cape Town, Cape Town, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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18
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Drak D, Dahwa R, Reakes E, Heron JE, Shamu T, Chimbetete C, Gracey DM. Baseline renal function predicts mortality in adolescents commenced on HIV antiretroviral therapy. AIDS 2021; 35:843-845. [PMID: 33724258 DOI: 10.1097/qad.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Douglas Drak
- Central Clinical School, University of Sydney, Camperdown
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Rumbi Dahwa
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Edward Reakes
- Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jack E Heron
- Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tinei Shamu
- Newlands Clinic, Newlands, Harare, Zimbabwe
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - David M Gracey
- Central Clinical School, University of Sydney, Camperdown
- Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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19
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Chimbetete C, Mudzviti T, Shamu T. Profile of elderly patients receiving antiretroviral therapy at Newlands Clinic in 2020: A cross-sectional study. South Afr J HIV Med 2020; 21:1164. [PMID: 33354366 PMCID: PMC7736656 DOI: 10.4102/sajhivmed.v21i1.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) face new challenges such as accelerated ageing and higher rates of comorbidities including cardiovascular, renal and metabolic diseases as they age. Objectives To profile the demographic and clinical characteristics of elderly patients receiving HIV care at Newlands Clinic (NC), Harare, Zimbabwe, as of 01 October 2019. Methods A cross-sectional analysis was conducted using clinic data. All patients who were 50 years and older on 01 October 2019 were enrolled. Descriptive statistics (medians, interquartile ranges [IQRs] and proportions) were used to describe patient demographic and clinical characteristics. Results Out of 6543 patients undergoing care at NC, 1688 (25.8%) were older than 50 years. The median duration of antiretroviral therapy (ART) was 10.9 years (IQR: 7.1–13). Over 90% of all patients had an HIV viral load below 50 copies/mL. Women were more likely than men to be overweight and obese (32% and 25% vs. 18% and 7%, respectively). Hypertension (41.2%), arthritis (19.9%) and chronic kidney disease (11.6%) were common comorbidities differently distributed based on sex. The most common malignancy diagnosed in women was cervical intra-epithelial neoplasia (68% of cancer burden in women) and Kaposi sarcoma was the leading malignancy in men (41% of cancer burden in men). Nearly 20% of patients had at least two chronic non-communicable comorbidities and 5.6% had at least three. Conclusion A high burden of comorbidities was observed amongst HIV-positive elderly patients receiving ART. Age-appropriate monitoring protocols must be developed to ensure optimum quality of care for elderly HIV-positive individuals.
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Affiliation(s)
| | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe.,School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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20
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Bleasel JM, Heron JE, Shamu T, Chimbetete C, Dahwa R, Gracey DM. Body mass index and noninfectious comorbidity in HIV-positive patients commencing antiretroviral therapy in Zimbabwe. HIV Med 2020; 21:674-679. [PMID: 32892487 DOI: 10.1111/hiv.12934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to describe the prevalence of elevated body mass index (BMI) in a cohort of treatment-naïve people living with HIV (PLWH) and to investigate the association of BMI with CD4 count and noninfectious comorbidities including hypertension and renal impairment. METHODS A retrospective cohort study of 1598 PLWH at the Newlands Clinic in Harare, Zimbabwe was carried out. Data were extracted from the medical records at baseline and 6 months after initiation of treatment. The univariate association between BMI and CD4 count was assessed and multiple regression models were used to predict factors associated with loss of renal function and change in CD4 count at 6 months. RESULTS Overweight and obesity (BMI ≥ 25 kg/m2 ) were prevalent in this cohort (34%), as was the presence of hypertension (18%). Higher BMI was associated with a higher CD4 count at baseline and 6 months (B = 0.28 and 0.24, respectively; P < 0.001 for both), adjusted for age and sex. The presence of hypertension independently predicted loss of renal function at 6 months (B = -15.31; P < 0.001), adjusted for BMI, CD4 count and sex. High BMI itself was also independently associated with a decline in renal function (B = -0.41; P = 0.003), adjusted for other significant variables. CONCLUSIONS We demonstrate a high prevalence of overweight/obesity and hypertension in an urban cohort of PLWH in Zimbabwe. Higher BMI was associated with a higher CD4 count, both before and 6 months after commencing antiretroviral therapy; it was also associated with loss of renal function in this cohort.
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Affiliation(s)
- J M Bleasel
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - J E Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - T Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - R Dahwa
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - D M Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
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21
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Chimbetete C, Shamu T, Roelens M, Bote S, Mudzviti T, Keiser O. Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe. PLoS One 2020; 15:e0237904. [PMID: 32853215 PMCID: PMC7451579 DOI: 10.1371/journal.pone.0237904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/05/2020] [Indexed: 12/30/2022] Open
Abstract
Background We report trends in mortality patterns and causes among HIV positive patients, who initiated antiretroviral therapy (ART), at an urban clinic in Harare, Zimbabwe. Methods A retrospective cohort study was conducted in which routinely collected data for patients enrolled and followed up between February 2004 and December 2017 were assessed. Patients follow up was from the day of the treatment initiation until exit by death, transfer out or loss to follow up. Two doctors categorized causes of death (COD) as tuberculosis (TB), communicable AIDS, non-communicable diseases (NCDs), malignancies, others and unknown. We used competing risk survival analysis, first to estimate all-causes and cause-specific mortality rates over time, and then to assess risk factors of different causes of death. Results A total of 4 868 patients were followed up for 27 527 person years (PY). Among the 506 patients who died, COD was unknown for 76 patients (15%) and common COD were TB (n = 71, 14%), Malignancies (n = 54, 10.7%) Meningitis (n = 39, 7.7%) and NCDs (n = 60, 11.9%). 49.4% of the deaths were within the first year of starting ART. Median age at death was 36 years (IQR:19–46). There was a near threefold increase in proportion of deaths due to NCDs and malignancies over the period of follow up. Low baseline CD4 cell count and WHO stages 3 & 4 were significant risk factors for all-cause mortality. Conclusions TB remains the leading cause of death among HIV infected people. Deaths due to NCDs and malignancies increased over time. ART facilities need to incorporate management of NCDs including cancer as part of comprehensive care of PLHIV to reduce mortality.
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Affiliation(s)
- Cleophas Chimbetete
- Newlands Clinic, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Maroussia Roelens
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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22
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Kouamou V, Varyani B, Shamu T, Mapangisana T, Chimbetete C, Mudzviti T, Manasa J, Katzenstein D. Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment. AIDS Res Hum Retroviruses 2020; 36:566-573. [PMID: 32138527 DOI: 10.1089/aid.2019.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Barriers to sustainable virologic suppression (VS) of HIV-infected adolescents and young adults include drug resistance mutations (DRMs) and limited treatment options, which may impact the outcome of second-line antiretroviral therapy (ART). We sequenced plasma viral RNA from 74 adolescents and young adults (16-24 years) failing first-line ART at Newlands Clinic, Zimbabwe between October 2015 and December 2016. We evaluated first-line nucleoside reverse transcriptase inhibitor (NRTI) susceptibility scores to first- and second-line regimens. Boosted protease inhibitor (bPI)-based ART was provided and viral load (VL) monitored for ≥48 weeks. Fisher's exact test was used to evaluate factors associated with VS on second-line regimens, defined as VL <1,000 copies/mL (VS1,000) or <50 copies/mL (VS50). The 74 participants on first-line ART had a median [interquartile range (IQR)] age of 18 (16-21) years and 42 (57%) were female. The mean (±standard deviation) duration on ART was 5.5 (±3.06) years and the median (IQR) log10 VL was 4.26 (3.78-4.83) copies/mL. After switching to a second-line PI regimen, 88% suppressed to <1,000 copies/mL and 76% to <50 copies/mL at ≥48 weeks. A new NRTI was associated with increased VS50 (p = .031). These 74 adolescents and young adults failing first-line ART demonstrated high levels (97%) of DRMs, despite enhanced adherence counseling. Switching to new NRTIs in second-line improved VS. With the widespread adoption of generic dolutegravir, lamivudine and tenofovir combinations in Africa, genotyping to determine NRTI susceptibility, may be warranted.
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Affiliation(s)
- Vinie Kouamou
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bhavini Varyani
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Tichaona Mapangisana
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Stellenbosch, South Africa
| | - Cleophas Chimbetete
- Newlands Clinic, Newlands, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Tinashe Mudzviti
- Newlands Clinic, Newlands, Harare, Zimbabwe
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Justen Manasa
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - David Katzenstein
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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23
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Chimbetete C, Shamu T, Keiser O. Zimbabwe's national third-line antiretroviral therapy program: Cohort description and treatment outcomes. PLoS One 2020; 15:e0228601. [PMID: 32119663 PMCID: PMC7051055 DOI: 10.1371/journal.pone.0228601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background In 2015, Zimbabwe introduced third-line antiretroviral therapy (ART) through four designated treatment centers; three government clinics in Harare and Bulawayo, and Newlands Clinic (NC), operated by a private voluntary organization in Harare. We describe characteristics of patients receiving third line ART and analyzed treatment outcomes in this national programme as of 31 December 2018. Methods We described the population using proportions for categorical variables, and medians and interquartile ranges for continuous variables. Patients from NC, where data were more complete, were followed from the date of starting third-line ART until death, transfer, loss to follow up or 31 December 2018. Results A total of 209 patients had ever received third-line ART: 124 at NC and 85 from the three government clinics. HIV genotype results were available for 89 (72%) patients at NC and fourteen (16.5%) patients in the government clinics. Median duration of third line ART (years) in the government clinics was 2.3 (IQR:0.6–3.4), 1.3 (IQR: 0.7–1.7) and 1 (0.6–1.9). Of the 67 patients who received third line ART in the government clinics for at least six months, 53 (79%) had most recent viral load (VL) < 1000 copies/ml. Data on other treatment outcomes from government clinics were incomplete. From NC: a total of 109 (88%) patients were still in care, 13 (10.5%) had died and 2 (1.5%) were transferred. Median duration of third-line ART was 1.4 years (IQR: 0.6–2.8). Among the 111 NC patients who had received third-line ART for at least 6 months, 83 (75%) had a VL <50 copies/ml and 106 (95.5%) had a VL <1000 copies/ml. Conclusion Our findings demonstrate that, with comprehensive care, patients failing second-line ART can achieve high rates of virological suppression on third-line regimens. There is need to decentralize the provision of third-line ART in Zimbabwe. More needs to be done to improve completeness of data in the government clinics.
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Affiliation(s)
- Cleophas Chimbetete
- Newlands Clinic, Harare, Zimbabwe.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Dahwa R, Shamu T, Heron J, Chimbetete C, Gracey D. SUN-080 Prevalence of renal impairment and proteinuria in HIV-infected patients before initiating ART at Newlands Clinic, Harare, Zimbabwe, between 2010 and 2018. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tsondai PR, Sohn AH, Phiri S, Sikombe K, Sawry S, Chimbetete C, Fatti G, Hobbins MA, Technau K, Rabie H, Bernheimer J, Fox MP, Judd A, Collins IJ, Davies M. Characterizing the double-sided cascade of care for adolescents living with HIV transitioning to adulthood across Southern Africa. J Int AIDS Soc 2020; 23:e25447. [PMID: 32003159 PMCID: PMC6992508 DOI: 10.1002/jia2.25447] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/26/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION As adolescents and young people living with HIV (AYLH) age, they face a "transition cascade," a series of steps associated with transitions in their care as they become responsible for their own healthcare. In high-income countries, this usually includes transfer from predominantly paediatric/adolescent to adult clinics. In sub-Saharan Africa, paediatric HIV care is mostly provided in decentralized, non-specialist primary care clinics, where "transition" may not necessarily include transfer of care but entails becoming more autonomous for one's HIV care. Using different age thresholds as proxies for when "transition" to autonomy might occur, we evaluated pre- and post-transition outcomes among AYLH. METHODS We included AYLH aged <16 years at enrolment, receiving antiretroviral therapy (ART) within International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) sites (2004 to 2017) with no history of transferring care. Using the ages of 16, 18, 20 and 22 years as proxies for "transition to autonomy," we compared the outcomes: no gap in care (≥2 clinic visits) and viral suppression (HIV-RNA <400 copies/mL) in the 12 months before and after each age threshold. Using log-binomial regression, we examined factors associated with no gap in care (retention) in the 12 months post-transition. RESULTS A total of 5516 AYLH from 16 sites were included at "transition" age 16 (transition-16y), 3864 at 18 (transition-18y), 1463 at 20 (transition-20y) and 440 at 22 years (transition-22y). At transition-18y, in the 12 months pre- and post-transition, 83% versus 74% of AYLH had no gap in care (difference 9.3 (95% confidence interval (CI) 7.8 to 10.9)); while 65% versus 62% were virally suppressed (difference 2.7 (-1.0 to 6.5%)). The strongest predictor of being retained post-transition was having no gap in the preceding year, across all transition age thresholds (transition-16y: adjusted risk ratio (aRR) 1.72; 95% CI (1.60 to 1.86); transition-18y: aRR 1.76 (1.61 to 1.92); transition-20y: aRR 1.75 (1.53 to 2.01); transition-22y: aRR 1.47; (1.21 to 1.78)). CONCLUSIONS AYLH with gaps in care need targeted support to prevent non-retention as they take on greater responsibility for their healthcare. Interventions to increase virologic suppression rates are necessary for all AYLH ageing to adulthood.
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Affiliation(s)
- Priscilla R Tsondai
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Sam Phiri
- Lighthouse Trust ClinicLilongweMalawi
| | | | - Shobna Sawry
- Harriet Shezi Children's ClinicWits Reproductive Health and HIV Research UnitUniversity of WitwatersrandJohannesburgSouth Africa
| | | | - Geoffrey Fatti
- Kheth'ImpiloCape TownSouth Africa
- Division of Epidemiology and BiostatisticsDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | | | - Karl‐Günter Technau
- Empilweni Services and Research UnitDepartment of Paediatrics & Child HealthRahima Moosa Mother and Child HospitalFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Helena Rabie
- Department of Paediatrics and Child HealthTygerberg Academic HospitalUniversity of StellenboschStellenboschSouth Africa
| | | | - Matthew P Fox
- Department of Global Health and Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Health Economics and Epidemiology Research OfficeFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Ali Judd
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUnited Kingdom
| | - Intira J Collins
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUnited Kingdom
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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Shawarira-Bote S, Shamu T, Chimbetete C. Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe. BMC Infect Dis 2019; 19:715. [PMID: 31409277 PMCID: PMC6693125 DOI: 10.1186/s12879-019-4332-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 07/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Gynecomastia is known to occur in some men taking an efavirenz-based antiretroviral therapy (ART) regimen. However, the incidence and outcomes of gynecomastia are not known in Zimbabwe. We described the characteristics and outcomes of gynecomastia among male patients on an efavirenz-based ART regimen. Methods We conducted a retrospective cohort review of data of all male patients aged ≥18 years taking an efavirenz-based regimen at Newlands Clinic, Harare, Zimbabwe before 31 March 2017. The primary outcome was gynecomastia as defined by breast/nipple enlargement reported by patient and confirmed by clinical palpation. Routinely collected data on demographics, baseline CD4, body mass index, duration on efavirenz, clinical presentation and outcomes were extracted from the clinic database and analysed using STATA 12.1. We investigated for any associations with concomitant medicines using cox regression. Results We analysed data for 1432 men with a median age of 40 years (IQR: 33–48). Half of the patients were in WHO stage 1 at ART commencement. Median body mass index and CD4 count at efavirenz commencement was 21 (IQR: 19–23) and 260 cells/mm3 (IQR: 126–412) respectively. The incidence of gynecomastia was 22/1000 person-years (IQR: 17.3–27.8). Over half of the cases (58%) were bilateral and 75% of all cases developed within two years of starting efavirenz. There were no significant associations with concomitant use of isoniazid (HR: 0.95, p = 0.87) or amlodipine (HR: 0.43, p = 0.24). Gynecomastia resolved in 83.5% of cases following withdrawal of efavirenz with a median time to resolution of 3 months (IQR: 2–9). Conclusion The incidence of gynecomastia among patients taking efavirenz-based ART was low with most cases developing early on during treatment. Most cases resolved completely after withdrawing efavirenz.
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Chimbetete C, Chirimuta L, Pascoe M, Keiser O. A case report of untreatable HIV infection in Harare, Zimbabwe. South Afr J HIV Med 2019; 20:885. [PMID: 31308964 PMCID: PMC6620492 DOI: 10.4102/sajhivmed.v20i1.885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/28/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Zimbabwe, like other resource limited countries, manages HIV infection using the public health approach with standard antiretroviral therapy (ART) regimens for first, second and third-line treatment. Third-line ART is the last available treatment option and is based on dolutegravir and darunavir use after HIV drug resistance testing. Patient Presentation We report here a 17-year-old patient on dolutegravir (DTG) and Darunavir based third-line antiretroviral therapy (ART) previously exposed to raltegravir who develops multidrug resistance HIV to the four ART classes available in Zimbabwe. Management and Outcome A trophism assay revealed that patient has CXCR4 trophic virus and hence will not benefit from Maraviroc. Patient is currently stable and receiving a holding regimen of abacavir, lamivudine and lamivudine. Conclusion This is the first documented case of multiclass resistance to the four available ART classes in Zimbabwe. The development and transmission of multiclass HIV drug resistance in resource limited settings has potential to undo the gains of national ART programs. There is need to ensure optimum adherence to ART even in the era of DTG.
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Affiliation(s)
- Cleophas Chimbetete
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Newlands Clinic, Harare, Zimbabwe
| | | | | | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Lowe S, Mudzviti T, Mandiriri A, Shamu T, Mudhokwani P, Chimbetete C, Luethy R, Pascoe M. Sexually transmitted infections, the silent partner in HIV-infected women in Zimbabwe. South Afr J HIV Med 2019; 20:849. [PMID: 30863622 PMCID: PMC6407315 DOI: 10.4102/sajhivmed.v20i1.849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/13/2018] [Indexed: 12/04/2022] Open
Abstract
Background Coinfection rates of HIV and sexually transmitted infections (STIs) are not widely reported in Zimbabwe and no local guidelines regarding the screening of STIs in people living with HIV exist. Objectives This cross-sectional study was conducted to determine the prevalence and associated risk factors for STI coinfection in a cohort of HIV-infected women. Methods Between January and June 2016, 385 HIV-infected women presenting for routine cervical cancer screening were tested for five STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Herpes Simplex Virus (HSV) type 2 and Treponema pallidum (TP). Socio-demographic characteristics and sexual history were recorded. Multiple logistic regression was used to identify factors associated with the diagnosis of non-viral STIs. Results Two hundred and thirty-three participants (60.5%) had a confirmed positive result for at least one STI: HSV 2 prevalence 52.5%, TV 8.1%, CT 2.1%, NG 1.8% and TP 11.4%. Eighty-seven per cent of the women were asymptomatic for any STI; 62.3% of women with a non-viral STI were asymptomatic. Women who had attended tertiary education were 90% less likely to have a non-viral STI (adjusted odds ratio [aOR]: 0.10, 95% confidence interval [CI]: 0.03–0.39, p < 0.01). Having more than three lifetime sexual partners was a significant predictor for a non-viral STI diagnosis (aOR: 3.3, 95% CI: 1.5–7.2, p < 0.01). Conclusion A high prevalence of predominantly asymptomatic STIs is reported in a cohort of HIV-infected women. Syndromic management results in underdiagnosis of asymptomatic patients. More than three lifetime sexual partners and less formal education are risk factors for coinfection with non-viral STI. High-risk women should be screened using aetiological methods.
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Affiliation(s)
- Sara Lowe
- AIDS Healthcare Foundation, Parirenyatwa Centre of Excellence, Parirenyatwa Hospital, Zimbabwe.,Department of Medicine, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Tinashe Mudzviti
- Newlands Clinic, Zimbabwe.,School of Pharmacy, College of Health Sciences, University of Zimbabwe, Zimbabwe
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Arrivé E, Ayaya S, Davies M, Chimbetete C, Edmonds A, Lelo P, Fong SM, Razali KA, Kouakou K, Duda SN, Leroy V, Vreeman RC. Models of support for disclosure of HIV status to HIV-infected children and adolescents in resource-limited settings. J Int AIDS Soc 2018; 21:e25157. [PMID: 29972632 PMCID: PMC6031071 DOI: 10.1002/jia2.25157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/13/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Disclosure of HIV status to HIV-infected children and adolescents is a major care challenge. We describe current site characteristics related to disclosure of HIV status in resource-limited paediatric HIV care settings within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS An online site assessment survey was conducted across the paediatric HIV care sites within six global regions of IeDEA. A standardized questionnaire was administered to the sites through the REDCap platform. RESULTS From June 2014 to March 2015, all 180 sites of the IeDEA consortium in 31 countries completed the online survey: 57% were urban, 43% were health centres and 86% were integrated clinics (serving both adults and children). Almost all the sites (98%) reported offering disclosure counselling services. Disclosure counselling was most often provided by counsellors (87% of sites), but also by nurses (77%), physicians (74%), social workers (68%), or other clinicians (65%). It was offered to both caregivers and children in 92% of 177 sites with disclosure counselling. Disclosure resources and procedures varied across geographical regions. Most sites in each region reported performing staff members' training on disclosure (72% to 96% of sites per region), routinely collecting HIV disclosure status (50% to 91%) and involving caregivers in the disclosure process (71% to 100%). A disclosure protocol was available in 14% to 71% of sites. Among the 143 sites (79%) routinely collecting disclosure status process, the main collection method was by asking the caregiver or child (85%) about the child's knowledge of his/her HIV status. Frequency of disclosure status assessment was every three months in 63% of the sites, and 71% stored disclosure status data electronically. CONCLUSION The majority of the sites reported offering disclosure counselling services, but educational and social support resources and capacities for data collection varied across regions. Paediatric HIV care sites worldwide still need specific staff members' training on disclosure, development and implementation of guidelines for HIV disclosure, and standardized data collection on this key issue to ensure the long-term health and wellbeing of HIV-infected youth.
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Affiliation(s)
- Elise Arrivé
- ISPEDCentre INSERM U1219‐ Epidémiologie‐BiostatistiqueUniversité de BordeauxBordeauxFrance
- INSERM U1219Centre Inserm Epidémiologie et BiostatistiqueUniversité de BordeauxBordeauxFrance
| | - Samuel Ayaya
- School of MedicineCollege of Health ScienceMoi UniversityEldoretKenya
| | | | | | - Andrew Edmonds
- Department of EpidemiologyGillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Patricia Lelo
- School of Public HealthThe University of KinshasaKinshasaCongo
| | | | | | | | | | | | - Rachel C Vreeman
- Indiana University School of MedicineIndianapolisINUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
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Schomaker M, Leroy V, Wolfs T, Technau KG, Renner L, Judd A, Sawry S, Amorissani-Folquet M, Noguera-Julian A, Tanser F, Eboua F, Navarro ML, Chimbetete C, Amani-Bosse C, Warszawski J, Phiri S, N'Gbeche S, Cox V, Koueta F, Giddy J, Sygnaté-Sy H, Raben D, Chêne G, Davies MA. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe. Int J Epidemiol 2018; 46:453-465. [PMID: 27342220 DOI: 10.1093/ije/dyw097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/08/2023] Open
Abstract
Background There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. Methods A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. Results Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. Conclusions Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.
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Affiliation(s)
- Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Valeriane Leroy
- Inserm, U1027, Université Paul Sabatier Toulouse 3 Toulouse, France
| | - Tom Wolfs
- Children's Hospital/UMCU, Department of Infectious Diseases, Utrecht, The Netherlands
| | - Karl-Günter Technau
- Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa.,Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana Medical School, Accra, Ghana
| | - Ali Judd
- MRC Clinical Trials Unit, University College London, London, UK
| | - Shobna Sawry
- University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Antoni Noguera-Julian
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa - CAPRISA, University of KwaZulu-Natal, Congella, South Africa
| | | | | | | | | | - Josiane Warszawski
- Centre de recherche en épidémiologie et santé des populations, 1018 Inserm, France
| | - Sam Phiri
- Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Sylvie N'Gbeche
- Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d'Ivoire
| | - Vivian Cox
- Médecins Sans Frontiéres South Africa, Cape Town, South Africa
| | - Fla Koueta
- Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso
| | - Janet Giddy
- Sinikithemba Clinic, McCord Hospital, Durban, South Africa
| | | | - Dorthe Raben
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geneviève Chêne
- University of Bordeaux Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d information médicale, F-33000 Bordeaux, France
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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Kouamou V, Katzenstein D, Shamu T, Chimbetete C. A4 Development of HIV drug resistance in HIV-infected patients failing second line regimen in Zimbabwe: A public health concern. Virus Evol 2018. [PMCID: PMC5905438 DOI: 10.1093/ve/vey010.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Kouamou
- Infectious Disease Research Laboratory, Department of Medicine, College of Health Science, University of Zimbabwe, Zimbabwe
| | - D Katzenstein
- Division of Infectious Disease, Stanford University Medical Center, USA
| | - T Shamu
- Newlands Clinic, Hospital, 56 Enterprise, Harare, Zimbabwe
| | - C Chimbetete
- Newlands Clinic, Hospital, 56 Enterprise, Harare, Zimbabwe
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Chimbetete C, Katzenstein D, Shamu T, Spoerri A, Estill J, Egger M, Keiser O. HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe. Open Forum Infect Dis 2018; 5:ofy005. [PMID: 29435471 PMCID: PMC5801603 DOI: 10.1093/ofid/ofy005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/23/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To analyze the patterns and risk factors of HIV drug resistance mutations among patients failing second-line treatment and to describe early treatment responses to recommended third-line antiretroviral therapy (ART) in a national referral HIV clinic in Zimbabwe. METHODS Patients on boosted protease inhibitor (PI) regimens for more than 6 months with treatment failure confirmed by 2 viral load (VL) tests >1000 copies/mL were genotyped, and susceptibility to available antiretroviral drugs was estimated by the Stanford HIVdb program. Risk factors for major PI resistance were assessed by logistic regression. Third-line treatment was provided as Darunavir/r, Raltegravir, or Dolutegravir and Zidovudine, Abacavir Lamivudine, or Tenofovir. RESULTS Genotypes were performed on 86 patients who had good adherence to treatment. The median duration of first- and second-line ART was 3.8 years (interquartile range [IQR], 2.3-5.1) and 2.6 years (IQR, 1.6-4.9), respectively. The median HIV viral load and CD4 cell count were 65 210 copies/mL (IQR, 8728-208 920 copies/mL) and 201 cells/mm3 (IQR, 49-333 cells/mm3). Major PI resistance-associated mutations (RAMs) were demonstrated in 44 (51%) non-nucleoside reverse transcriptase inhibitor RAMs in 72 patients (83%) and nucleoside reverse transcriptase inhibitors RAMs in 62 patients (72%). PI resistance was associated with age >24 years (P = .003) and CD4 cell count <200 cells/mm3 (P = .007). In multivariable analysis, only age >24 years was significantly associated (adjusted odds ratio, 4.75; 95% confidence interval, 1.69-13.38; P = .003) with major PI mutations. Third-line DRV/r- and InSTI-based therapy achieved virologic suppression in 29/36 patients (81%) after 6 months. CONCLUSIONS The prevelance of PI mutations was high. Adolescents and young adults had a lower risk of acquiring major PI resistance mutations, possibly due to poor adherence to ART. Third-line treatment with a regimen of Darunavir/r, Raltegravir/Dolutegravir, and optimized nucleoside reverse transcriptase inhibitors was effective.
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Affiliation(s)
- Cleophas Chimbetete
- Institute of Global Health, University of Geneva, Geneva, Switzerl
- Newlands Clinic, Harare, Zimbabwe
| | | | | | - Adrian Spoerri
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerl
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerl
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerl
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerl
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerl
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerl
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerl
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Ballif M, Zürcher K, Reid SE, Boulle A, Fox MP, Prozesky HW, Chimbetete C, Zwahlen M, Egger M, Fenner L. Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes. BMJ Open 2018; 8:e017405. [PMID: 29330173 PMCID: PMC5780693 DOI: 10.1136/bmjopen-2017-017405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa. SETTING Five ART programmes participating in the International Epidemiology Database to Evaluate AIDS in South Africa, Zambia and Zimbabwe. PARTICIPANTS We analysed data of 331 634 HIV-positive adults (>15 years), who initiated ART between January 2004 and December 2014. PRIMARY OUTCOME MEASURE We calculated aggregated averages in monthly counts of PTB diagnoses and ART initiations. To account for time trends, we compared deviations of monthly event counts to yearly averages, and calculated correlation coefficients. We used multivariable regressions to assess associations between deviations of monthly ART initiation and PTB diagnosis counts from yearly averages, adjusted for monthly air temperatures and geographical latitude. As controls, we used Kaposi sarcoma and extrapulmonary tuberculosis (EPTB) diagnoses. RESULTS All programmes showed monthly variations in PTB diagnoses that paralleled fluctuations in ART initiations, with recurrent patterns across 2004-2014. The strongest drops in PTB diagnoses occurred in December, followed by April-May in Zimbabwe and South Africa. This corresponded to holiday seasons, when clinical activities are reduced. We observed little monthly variation in ART initiations and PTB diagnoses in Zambia. Correlation coefficients supported parallel trends in ART initiations and PTB diagnoses (correlation coefficient: 0.28, 95% CI 0.21 to 0.35, P<0.001). Monthly temperatures and latitude did not substantially change regression coefficients between ART initiations and PTB diagnoses. Trends in Kaposi sarcoma and EPTB diagnoses similarly followed changes in ART initiations throughout the year. CONCLUSIONS Monthly variations in PTB diagnosis at ART programmes in Southern Africa likely occurred regardless of seasonal variations in temperatures or latitude and reflected fluctuations in clinical activities and changes in health-seeking behaviour throughout the year, rather than climatic factors.
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Affiliation(s)
- Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Stewart E Reid
- Division of Infection Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Tuberculosis Department Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Matthew P Fox
- Departments of Epidemiology and Global Health, Boston University, Boston, USA
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, University of Stellenbosch & Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
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Shamu T, Chimbetete C, Shawarira–Bote S, Mudzviti T, Luthy R. Outcomes of an HIV cohort after a decade of comprehensive care at Newlands Clinic in Harare, Zimbabwe: TENART cohort. PLoS One 2017; 12:e0186726. [PMID: 29065149 PMCID: PMC5655537 DOI: 10.1371/journal.pone.0186726] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Data on long-term outcomes of patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are few. We describe outcomes of patients commenced on ART at Newlands Clinic between 2004 and 2006 after ≥10 years of comprehensive care including, psychosocial, adherence and food support. Methods In this retrospective cohort study, patient data from an electronic medical record collected during routine care were analysed. We describe baseline characteristics, virological and clinical outcomes, attrition rates, and treatment adverse effects until November 2016. We defined virological suppression as viral load <50 copies/ml and virological failure as >1000 copies/ml after ≥6 months of ART. Results We analysed data for 605 patients (67% female) who commenced ART, and were followed-up for 5819 person-years (median: 10.7 years, IQR: 10.1–11.4). Median age at ART initiation was 34 years (IQR: 17–42). Pre-ART, 129 (21.3%) patients had history of pulmonary tuberculosis (PTB). In care, 66 (11%) developed PTB, and 24 (4%) developed extrapulmonary tuberculosis. 385 (63.6%) patients experienced ≥1 adverse event, the most frequent being stavudine-induced peripheral neuropathy (n = 252, 41.7%). At database closure on 14 November 2016, 474 (78.3%) patients were still in care, 428 (90.3%) being virologically suppressed, and 21 (4.4%) failing. While 483 (79.8%) remained on first line, 122 (20.2%) were switched to second line ART. Fifty-nine patients (9.8%) were transferred to other ART facilities, 45 (7.4%) were lost to follow-up, 25 (4.1%) died, and two stopped ART. Conclusion Comprehensive HIV care can result in low mortality, high retention in care and virologic suppression rates in resource limited settings.
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Affiliation(s)
- Tinei Shamu
- Newlands Clinic, Highlands, Harare, Zimbabwe
- * E-mail:
| | | | | | - Tinashe Mudzviti
- Newlands Clinic, Highlands, Harare, Zimbabwe
- School of Pharmacy, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Ruedi Luthy
- Newlands Clinic, Highlands, Harare, Zimbabwe
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Chimbetete C, Mugglin C, Shamu T, Kalesan B, Bertisch B, Egger M, Keiser O. New-onset type 2 diabetes mellitus among patients receiving HIV care at Newlands Clinic, Harare, Zimbabwe: retrospective cohort analysis. Trop Med Int Health 2017; 22:839-845. [PMID: 28510998 PMCID: PMC5662202 DOI: 10.1111/tmi.12896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the incidence and associated factors of Type 2 Diabetes Mellitus (T2DM) among people living with HIV (PLHIV) in Zimbabwe. METHODS We analysed data of all HIV-infected patients older than 16 years who attended Newlands Clinic between March 1, 2004 and April 29, 2015. The clinic considers patients whose random blood sugar is higher than 11.1 mmol/l and which is confirmed by a fasting blood sugar higher than 7.0 mmol/l to have T2DM. T2DM is also diagnosed in symptomatic patients who have a RBS >11.0 mmol/l. Risk factors for developing T2DM were identified using Cox proportional hazard models adjusted for confounding. Missing baseline BMI data were multiply imputed. Results are presented as adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI). RESULTS Data for 4,110 participants were included: 67.2% were women; median age was 37 (IQR: 31-43) years. Median baseline CD4 count was 197 (IQR: 95-337) cells/mm3 . The proportion of participants with hypertension at baseline was 15.5% (n=638). Over a median follow-up time of 4.7 (IQR: 2.1-7.2) years, 57 patients developed T2DM; the overall incidence rate was 2.8 (95% CI: 2.1-3.6) per 1000 person-years of follow-up. Exposure to PIs was associated with T2DM (HR: 1.80, 95% CI: 1.04-3.09). In the multivariable analysis, obesity (BMI>30 kg/m2 ) (aHR=2.26, 95% CI: 1.17-4.36), age >40 years (aHR=2.16, 95% CI: 1.22-3.83) and male gender, (aHR=2.13, 95% CI: 1.22-3.72) were independently associated with the risk of T2DM. HIV-related factors (baseline CD4 cell count and baseline WHO clinical stage) were not independent risk factors for developing T2DM. CONCLUSION Although the incidence of T2DM in this HIV cohort was lower than that has been observed in others, our results show that risk factors for developing T2DM among HIV-infected people are similar to those of the general population. HIV-infected patients in sub-Saharan Africa need a comprehensive approach to care that includes better health services for prevention, early detection and treatment of chronic diseases especially among the elderly and obese.
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Affiliation(s)
- Cleophas Chimbetete
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Newlands Clinic, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - Bindu Kalesan
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, USA
| | - Barbara Bertisch
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, USA
- Checkpoint Zuerich, Zürich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
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Chimukangara B, Varyani B, Shamu T, Mutsvangwa J, Manasa J, White E, Chimbetete C, Luethy R, Katzenstein D. HIV drug resistance testing among patients failing second line antiretroviral therapy. Comparison of in-house and commercial sequencing. J Virol Methods 2017; 243:151-157. [PMID: 27894862 PMCID: PMC5393912 DOI: 10.1016/j.jviromet.2016.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION HIV genotyping is often unavailable in low and middle-income countries due to infrastructure requirements and cost. We compared genotype resistance testing in patients with virologic failure, by amplification of HIV pol gene, followed by "in-house" sequencing and commercial sequencing. METHODS Remnant plasma samples from adults and children failing second-line ART were amplified and sequenced using in-house and commercial di-deoxysequencing, and analyzed in Harare, Zimbabwe and at Stanford, U.S.A, respectively. HIV drug resistance mutations were determined using the Stanford HIV drug resistance database. RESULTS Twenty-six of 28 samples were amplified and 25 were successfully genotyped. Comparison of average percent nucleotide and amino acid identities between 23 pairs sequenced in both laboratories were 99.51 (±0.56) and 99.11 (±0.95), respectively. All pairs clustered together in phylogenetic analysis. Sequencing analysis identified 6/23 pairs with mutation discordances resulting in differences in phenotype, but these did not impact future regimens. CONCLUSIONS The results demonstrate our ability to produce good quality drug resistance data in-house. Despite discordant mutations in some sequence pairs, the phenotypic predictions were not clinically significant.
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Affiliation(s)
- Benjamin Chimukangara
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa.
| | - Bhavini Varyani
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Tinei Shamu
- Newlands Clinic, Newlands, Harare, Zimbabwe.
| | - Junior Mutsvangwa
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Justen Manasa
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Elizabeth White
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Cleophas Chimbetete
- Newlands Clinic, Newlands, Harare, Zimbabwe; Institute of Social and Preventive Medicine, University of Bern, Switzerland.
| | | | - David Katzenstein
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Rohner E, Schmidlin K, Zwahlen M, Chakraborty R, Clifford G, Obel N, Grabar S, Verbon A, Noguera-Julian A, Collins IJ, Rojo P, Brockmeyer N, Campbell M, Chêne G, Prozesky H, Eley B, Stefan DC, Davidson A, Chimbetete C, Sawry S, Davies MA, Kariminia A, Vibol U, Sohn A, Egger M, Bohlius J. Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia. Clin Infect Dis 2016; 63:1245-1253. [PMID: 27578823 PMCID: PMC5064163 DOI: 10.1093/cid/ciw519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/21/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)-infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally. METHODS We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged <16 years at cART initiation from 1996 onward. We used Cox models to calculate hazard ratios (HRs), adjusted for region and origin, sex, cART start year, age, and HIV/AIDS stage at cART initiation. RESULTS We included 24 991 children from eastern Africa, southern Africa, Europe and Asia; 26 developed KS after starting cART. Incidence rates per 100 000 person-years (PYs) were 86 in eastern Africa (95% confidence interval [CI], 55-133), 11 in southern Africa (95% CI, 4-35), and 81 (95% CI, 26-252) in children of sub-Saharan African (SSA) origin in Europe. The KS incidence rates were 0/100 000 PYs in children of non-SSA origin in Europe (95% CI, 0-50) and in Asia (95% CI, 0-27). KS risk was lower in girls than in boys (adjusted HR [aHR], 0.3; 95% CI, .1-.9) and increased with age (10-15 vs 0-4 years; aHR, 3.4; 95% CI, 1.2-10.1) and advanced HIV/AIDS stage (CDC stage C vs A/B; aHR, 2.4; 95% CI, .8-7.3) at cART initiation. CONCLUSIONS HIV-infected children from SSA but not those from other regions, have a high risk of developing KS after cART initiation. Early cART initiation in these children might reduce KS risk.
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Boender TS, Hamers RL, Ondoa P, Wellington M, Chimbetete C, Siwale M, Labib Maksimos EEF, Balinda SN, Kityo CM, Adeyemo TA, Akanmu AS, Mandaliya K, Botes ME, Stevens W, Rinke de Wit TF, Sigaloff KCE. Protease Inhibitor Resistance in the First 3 Years of Second-Line Antiretroviral Therapy for HIV-1 in Sub-Saharan Africa. J Infect Dis 2016; 214:873-83. [PMID: 27402780 DOI: 10.1093/infdis/jiw219] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/19/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As antiretroviral therapy (ART) programs in sub-Saharan Africa mature, increasing numbers of persons with human immunodeficiency virus (HIV) infection will experience treatment failure, and require second- or third-line ART. Data on second-line failure and development of protease inhibitor (PI) resistance in sub-Saharan Africa are scarce. METHODS HIV-1-infected adults were included if they received >180 days of PI-based second-line ART. We assessed risk factors for having a detectable viral load (VL, ≥400 cps/mL) using Cox models. If VL was ≥1000 cps/mL, genotyping was performed. RESULTS Of 227 included participants, 14.6%, 15.2% and 11.1% had VLs ≥400 cps/mL at 12, 24, and 36 months, respectively. Risk factors for a detectable VL were as follows: exposure to nonstandard nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based (hazard ratio, 7.10; 95% confidence interval, 3.40-14.83; P < .001) or PI-based (7.59; 3.02-19.07; P = .001) first-line regimen compared with zidovudine/lamivudine/NNRTI, PI resistance at switch (6.69; 2.49-17.98; P < .001), and suboptimal adherence (3.05; 1.71-5.42; P = .025). Among participants with VLs ≥1000 cps/mL, 22 of 32 (69%) harbored drug resistance mutation(s), and 7 of 32 (22%) harbored PI resistance. CONCLUSIONS Although VL suppression rates were high, PI resistance was detected in 22% of participants with VLs ≥1000 cps/mL. To ensure long-term ART success, intensified support for adherence, VL and drug resistance testing, and third-line drugs will be necessary.
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Affiliation(s)
- T Sonia Boender
- Amsterdam Institute for Global Health and Development, Department of Global Health
| | - Raph L Hamers
- Amsterdam Institute for Global Health and Development, Department of Global Health Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Pascale Ondoa
- Amsterdam Institute for Global Health and Development, Department of Global Health
| | | | | | | | | | | | | | - Titilope A Adeyemo
- Department of Haematology & Blood transfusion, College of Medicine of the University of Lagos, Nigeria
| | - Alani Sulaimon Akanmu
- Department of Haematology & Blood transfusion, College of Medicine of the University of Lagos, Nigeria
| | | | | | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, and the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Kim C E Sigaloff
- Amsterdam Institute for Global Health and Development, Department of Global Health Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
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Mudzviti T, Mandizvidza T, Ngara B, Chimbetete C, Maponga CC, Morse GD. 004.4 Pill dumping in adolescents receiving a boosted protease inhibitor regimen as part of second-line antiretroviral therapy: experiences from an urban HIV clinic. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Haas AD, Keiser O, Balestre E, Brown S, Bissagnene E, Chimbetete C, Dabis F, Davies MA, Hoffmann CJ, Oyaro P, Parkes-Ratanshi R, Reynolds SJ, Sikazwe I, Wools-Kaloustian K, Zannou DM, Wandeler G, Egger M. Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis. Lancet HIV 2015; 2:e271-8. [PMID: 26423252 DOI: 10.1016/s2352-3018(15)00087-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND HIV-1 viral load testing is recommended to monitor antiretroviral therapy (ART) but is not universally available. The aim of our study was to assess monitoring of first-line ART and switching to second-line ART in sub-Saharan Africa. METHODS We did a collaborative analysis of cohort studies from 16 countries in east Africa, southern Africa, and west Africa that participate in the international epidemiological database to evaluate AIDS (IeDEA). We included adults infected with HIV-1 who started combination ART between January, 2004, and January, 2013. We defined switching of ART as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to one including a protease inhibitor, with adjustment of one or more nucleoside reverse-transcriptase inhibitors (NRTIs). Virological and immunological failures were defined according to WHO criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% CIs comparing routine viral load monitoring, targeted viral load monitoring, CD4 monitoring, and clinical monitoring, adjusting for programme and individual characteristics. FINDINGS Of 297,825 eligible patients, 10,352 (3%) switched to second-line ART during 782 ,412 person-years of follow-up. Compared with CD4 monitoring, hazard ratios for switching were 3·15 (95% CI 2·92-3·40) for routine viral load monitoring, 1·21 (1·13-1·30) for targeted viral load monitoring, and 0·49 (0·43-0·56) for clinical monitoring. Of 6450 patients with confirmed virological failure, 58·0% (95% CI 56·5-59·6) switched by 2 years, and of 15,892 patients with confirmed immunological failure, 19·3% (18·5-20·0) switched by 2 years. Of 10,352 patients who switched, evidence of treatment failure based on one CD4 count or viral load measurement ranged from 86 (32%) of 268 patients with clinical monitoring to 3754 (84%) of 4452 with targeted viral load monitoring. Median CD4 counts at switching were 215 cells per μL (IQR 117-335) with routine viral load monitoring, but were lower with other types of monitoring (range 114-133 cells per μL). INTERPRETATION Overall, few patients switched to second-line ART and switching happened late in the absence of routine viral load monitoring. Switching was more common and happened earlier after initiation of ART with targeted or routine viral load testing. FUNDING National Institute of Allergy and Infectious Diseases, Swiss National Science Foundation.
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Affiliation(s)
- Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eric Balestre
- Centre de Recherche INSERM U897, Epidemiologie-Biostatistique, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France
| | - Steve Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emmanuel Bissagnene
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | | | - François Dabis
- Centre de Recherche INSERM U897, Epidemiologie-Biostatistique, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Christopher J Hoffmann
- Johns Hopkins University, Baltimore, MD, USA; Aurum Institute, Johannesburg, South Africa
| | - Patrick Oyaro
- Kenya Medical Research Institute - RCTP FACES Program, Kisumu, Kenya
| | | | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - D Marcel Zannou
- Faculté des Sciences de la Santé de l'Université d'Abomey-Calavi, and Centre de Traitement Ambulatoire du Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
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Mudzviti T, Mudzongo NT, Gavi S, Chimbetete C, Maponga CC, Morse GD. A Time to Event Analysis of Adverse Drug Reactions Due to Tenofovir, Zidovudine and Stavudine in a Cohort of Patients Receiving Antiretroviral Treatment at an Outpatient Clinic in Zimbabwe. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/pp.2015.63021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Davies MA, May M, Bolton-Moore C, Chimbetete C, Eley B, Garone D, Giddy J, Moultrie H, Ndirangu J, Phiri S, Rabie H, Technau K, Wood R, Boulle A, Egger M, Keiser O. Prognosis of children with HIV-1 infection starting antiretroviral therapy in Southern Africa: a collaborative analysis of treatment programs. Pediatr Infect Dis J 2014; 33:608-16. [PMID: 24378936 PMCID: PMC4349941 DOI: 10.1097/inf.0000000000000214] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prognostic models for children starting antiretroviral therapy (ART) in Africa are lacking. We developed models to estimate the probability of death during the first year receiving ART in Southern Africa. METHODS We analyzed data from children ≤10 years of age who started ART in Malawi, South Africa, Zambia or Zimbabwe from 2004 to 2010. Children lost to follow up or transferred were excluded. The primary outcome was all-cause mortality in the first year of ART. We used Weibull survival models to construct 2 prognostic models: 1 with CD4%, age, World Health Organization clinical stage, weight-for-age z-score (WAZ) and anemia and the other without CD4%, because it is not routinely measured in many programs. We used multiple imputation to account for missing data. RESULTS Among 12,655 children, 877 (6.9%) died in the first year of ART. We excluded 1780 children who were lost to follow up/transferred from main analyses; 10,875 children were therefore included. With the CD4% model probability of death at 1 year ranged from 1.8% [95% confidence interval (CI): 1.5-2.3] in children 5-10 years with CD4% ≥10%, World Health Organization stage I/II, WAZ ≥ -2 and without severe anemia to 46.3% (95% CI: 38.2-55.2) in children <1 year with CD4% < 5%, stage III/IV, WAZ< -3 and severe anemia. The corresponding range for the model without CD4% was 2.2% (95% CI: 1.8-2.7) to 33.4% (95% CI: 28.2-39.3). Agreement between predicted and observed mortality was good (C-statistics = 0.753 and 0.745 for models with and without CD4%, respectively). CONCLUSIONS These models may be useful to counsel children/caregivers, for program planning and to assess program outcomes after allowing for differences in patient disease severity characteristics.
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Affiliation(s)
- Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, UK
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia and University of North Caroline at Chapel Hill, USA
| | | | - Brian Eley
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Daniela Garone
- Médecins Sans Frontières (MSF) South Africa and Khayelitsha ART Programme, Cape Town, South Africa
| | - Janet Giddy
- Sinikithemba Clinic, McCord Hospital, Durban, South Africa
| | - Harry Moultrie
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg and Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - James Ndirangu
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Sam Phiri
- Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi and Liverpool School of Tropical Medicine Liverpool, UK
| | - Helena Rabie
- Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | - Karl Technau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, and University of Witwatersrand, Johannesburg, South Africa
| | - Robin Wood
- Gugulethu ART Programme and Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Andrew Boulle
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Matthias Egger
- School of Public Health and Family Medicine, University of Cape Town, South Africa
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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Avila D, Althoff KN, Mugglin C, Wools-Kaloustian K, Koller M, Dabis F, Nash D, Gsponer T, Sungkanuparph S, McGowan C, May M, Cooper D, Chimbetete C, Wolff M, Collier A, McManus H, Davies MA, Costagliola D, Crabtree-Ramirez B, Chaiwarith R, Cescon A, Cornell M, Diero L, Phanuphak P, Sawadogo A, Ehmer J, Eholie SP, Li PCK, Fox MP, Gandhi NR, González E, Lee CKC, Hoffmann CJ, Kambugu A, Keiser O, Ditangco R, Prozesky H, Lampe F, Kumarasamy N, Kitahata M, Lugina E, Lyamuya R, Vonthanak S, Fink V, d'Arminio Monforte A, Luz PM, Chen YMA, Minga A, Casabona J, Mwango A, Choi JY, Newell ML, Bukusi EA, Ngonyani K, Merati TP, Otieno J, Bosco MB, Phiri S, Ng OT, Anastos K, Rockstroh J, Santos I, Oka S, Somi G, Stephan C, Teira R, Wabwire D, Wandeler G, Boulle A, Reiss P, Wood R, Chi BH, Williams C, Sterne JA, Egger M. Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 2014; 65:e8-16. [PMID: 24419071 PMCID: PMC3894575 DOI: 10.1097/qai.0b013e3182a39979] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. METHODS Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. RESULTS In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): -56 to +30] lower in LMIC, 22 cells/μL (-62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage. CONCLUSIONS Median CD4 cell counts at the start of cART increased 2000-2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.
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Wandeler G, Gerber F, Rohr J, Chi BH, Orrell C, Chimbetete C, Prozesky H, Boulle A, Hoffmann CJ, Gsponer T, Fox MP, Zwahlen M, Egger M. Tenofovir or zidovudine in second-line antiretroviral therapy after stavudine failure in southern Africa. Antivir Ther 2013; 19:521-5. [PMID: 24296645 DOI: 10.3851/imp2710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is debate over using tenofovir or zidovudine alongside lamivudine in second-line antiretroviral therapy (ART) following stavudine failure. We analysed outcomes in cohorts from South Africa, Zambia and Zimbabwe METHODS Patients aged ≥16 years who switched from a first-line regimen including stavudine to a ritonavir-boosted lopinavir-based second-line regimen with lamivudine or emtricitabine and zidovudine or tenofovir in seven ART programmes in southern Africa were included. We estimated the causal effect of receiving tenofovir or zidovudine on mortality and virological failure using Cox proportional hazards marginal structural models. Its parameters were estimated using inverse probability of treatment weights. Baseline characteristics were age, sex, calendar year and country. CD4(+) T-cell count, creatinine and haemoglobin levels were included as time-dependent confounders. RESULTS A total of 1,256 patients on second-line ART, including 958 on tenofovir, were analysed. Patients on tenofovir were more likely to have switched to second-line ART in recent years, spent more time on first-line ART (33 versus 24 months) and had lower CD4(+) T-cell counts (172 versus 341 cells/μl) at initiation of second-line ART. The adjusted hazard ratio comparing tenofovir with zidovudine was 1.00 (95% CI 0.59, 1.68) for virological failure and 1.40 (0.57, 3.41) for death. CONCLUSIONS We did not find any difference in treatment outcomes between patients on tenofovir or zidovudine; however, the precision of our estimates was limited. There is an urgent need for randomized trials to inform second-line ART strategies in resource-limited settings.
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Affiliation(s)
- Gilles Wandeler
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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Bohlius J, Valeri F, Maskew M, Prozesky H, Chimbetete C, Lumano-Mulenga P, Gsponer T, Egger M. Incidence of Kaposi sarcoma in HIV-infected patients receiving antiretroviral therapy: A prospective multicohort study from southern Africa. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mugyenyi P, Walker AS, Hakim J, Munderi P, Gibb DM, Kityo C, Reid A, Grosskurth H, Darbyshire JH, Ssali F, Bray D, Katabira E, Babiker AG, Gilks CF, Grosskurth H, Munderi P, Kabuye G, Nsibambi D, Kasirye R, Zalwango E, Nakazibwe M, Kikaire B, Nassuna G, Massa R, Fadhiru K, Namyalo M, Zalwango A, Generous L, Khauka P, Rutikarayo N, Nakahima W, Mugisha A, Todd J, Levin J, Muyingo S, Ruberantwari A, Kaleebu P, Yirrell D, Ndembi N, Lyagoba F, Hughes P, Aber M, Lara AM, Foster S, Amurwon J, Wakholi BN, Whitworth J, Wangati K, Amuron B, Kajungu D, Nakiyingi J, Omony W, Fadhiru K, Nsibambi D, Khauka P, Mugyenyi P, Kityo C, Ssali F, Tumukunde D, Otim T, Kabanda J, Musana H, Akao J, Kyomugisha H, Byamukama A, Sabiiti J, Komugyena J, Wavamunno P, Mukiibi S, Drasiku A, Byaruhanga R, Labeja O, Katundu P, Tugume S, Awio P, Namazzi A, Bakeinyaga GT, Katabira H, Abaine D, Tukamushaba J, Anywar W, Ojiambo W, Angweng E, Murungi S, Haguma W, Atwiine S, Kigozi J, Namale L, Mukose A, Mulindwa G, Atwiine D, Muhwezi A, Nimwesiga E, Barungi G, Takubwa J, Murungi S, Mwebesa D, Kagina G, Mulindwa M, Ahimbisibwe F, Mwesigwa P, Akuma S, Zawedde C, Nyiraguhirwa D, Tumusiime C, Bagaya L, Namara W, Kigozi J, Karungi J, Kankunda R, Enzama R, Latif A, Hakim J, Robertson V, Reid A, Chidziva E, Bulaya-Tembo R, Musoro G, Taziwa F, Chimbetete C, Chakonza L, Mawora A, Muvirimi C, Tinago G, Svovanapasis P, Simango M, Chirema O, Machingura J, Mutsai S, Phiri M, Bafana T, Chirara M, Muchabaiwa L, Muzambi M, Mutowo J, Chivhunga T, Chigwedere E, Pascoe M, Warambwa C, Zengeza E, Mapinge F, Makota S, Jamu A, Ngorima N, Chirairo H, Chitsungo S, Chimanzi J, Maweni C, Warara R, Matongo M, Mudzingwa S, Jangano M, Moyo K, Vere L, Mdege N, Machingura I, Katabira E, Ronald A, Kambungu A, Lutwama F, Mambule I, Nanfuka A, Walusimbi J, Nabankema E, Nalumenya R, Namuli T, Kulume R, Namata I, Nyachwo L, Florence A, Kusiima A, Lubwama E, Nairuba R, Oketta F, Buluma E, Waita R, Ojiambo H, Sadik F, Wanyama J, Nabongo P, Oyugi J, Sematala F, Muganzi A, Twijukye C, Byakwaga H, Ochai R, Muhweezi D, Coutinho A, Etukoit B, Gilks C, Boocock K, Puddephatt C, Grundy C, Bohannon J, Winogron D, Gibb DM, Burke A, Bray D, Babiker A, Walker AS, Wilkes H, Rauchenberger M, Sheehan S, Spencer-Drake C, Taylor K, Spyer M, Ferrier A, Naidoo B, Dunn D, Goodall R, Darbyshire JH, Peto L, Nanfuka R, Mufuka-Kapuya C, Kaleebu P, Pillay D, Robertson V, Yirrell D, Tugume S, Chirara M, Katundu P, Ndembi N, Lyagoba F, Dunn D, Goodall R, McCormick A, Lara AM, Foster S, Amurwon J, Wakholi BN, Kigozi J, Muchabaiwa L, Muzambi M, Weller I, Babiker A, Bahendeka S, Bassett M, Wapakhabulo AC, Darbyshire JH, Gazzard B, Gilks C, Grosskurth H, Hakim J, Latif A, Mapuchere C, Mugurungi O, Mugyenyi P, Burke C, Jones S, Newland C, Pearce G, Rahim S, Rooney J, Smith M, Snowden W, Steens JM, Breckenridge A, McLaren A, Hill C, Matenga J, Pozniak A, Serwadda D, Peto T, Palfreeman A, Borok M, Katabira E. Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial. Lancet 2010; 375:123-31. [PMID: 20004464 PMCID: PMC2805723 DOI: 10.1016/s0140-6736(09)62067-5] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa. METHODS In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779. FINDINGS Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases). INTERPRETATION ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment. FUNDING UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories.
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