66 research outputs found
Incidence of Kaposi Sarcoma in HIV-infected patients – a prospective multi-cohort study from Southern Africa
Oral presentation presented at the 13th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) Bethesda, MD, USA. 7-8 November 2011The original publication is available at http://www.infectagentscancer.com/content/7/S1/O20Background: The incidence of Kaposi Sarcoma (KS) is high in sub-Saharan Africa. Data on KS among HIV-infected patients receiving and not yet receiving antiretroviral therapy (ART) are, however, scarce in Africa. Within the framework of a large multi-cohort project, the International epidemiologic Database to Evaluate AIDS (IeDEA), we estimate the incidence and risk factors for
the development of KS in HIV-infected patients in Southern Africa.Publishers' Versio
Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study.
Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART
Pooled HIV-1 Viral Load Testing Using Dried Blood Spots to Reduce the Cost of Monitoring Antiretroviral Treatment in a Resource-Limited Setting
: Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi
Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening.
In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries
Tenofovir in second-line ART in Zambia and South Africa: collaborative analysis of cohort studies
Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA)
Khayelitsha 2001 - 2011: 10 years of primary care HIV and TB programmes
Tuberculosis (TB) and HIV care in Khayelitsha, and in South Africa as a whole, has overcome numerous obstacles in the past three decades. This article highlights what has been achieved in Khayelitsha, describes the key clinical programme and policy changes that have supported universal coverage for HIV and TB care over the last 10 years, and outlines the challenges for the next decade
Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study
Background. We compared Kaposi sarcoma (KS) risk in adults who started
antiretroviral therapy (ART) across the Asia-Pacific, South Africa,
Europe, Latin, and North America.
Methods. We included cohort data of human immunodeficiency virus
(HIV)-positive adults who started ART after 1995 within the framework of
2 large collaborations of observational HIV cohorts. We present
incidence rates and adjusted hazard ratios (aHRs).
Results. We included 208 140 patients from 57 countries. Over a period
of 1 066 572 person-years, 2046 KS cases were diagnosed. KS incidence
rates per 100 000 person-years were 52 in the Asia-Pacific and ranged
between 180 and 280 in the other regions. KS risk was 5 times higher in
South African women (aHR, 4.56; 95% confidence intervals [CI],
2.73-7.62) than in their European counterparts, and 2 times higher in
South African men (2.21; 1.34-3.63). In Europe, Latin, and North America
KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95%
CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell
counts >= 700 cells/mu L with those whose counts were <50 cells/mu L,
the KS risk was halved in South Africa (aHR, 0.53; 95% CI,.17-1.63) but
reduced by >= 95% in other regions.
Conclusions. Despite important ART-related declines in KS incidence, men
and women in South Africa and men who have sex with men remain at
increased KS risk, likely due to high human herpesvirus 8 coinfection
rates. Early ART initiation and maintenance of high CD4 cell counts are
essential to further reducing KS incidence worldwide, but additional
measures might be needed, especially in Southern Africa
Kaposi's Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era
The incidence of Kaposi's Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. A total of 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406-2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102-187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13-0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9-80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to prevent KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV
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