Convergence of Mortality Rates among Patients on Antiretroviral Therapy in South Africa and North America
| العنوان: | Convergence of Mortality Rates among Patients on Antiretroviral Therapy in South Africa and North America |
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| المؤلفون: | Susana Monge, Jodie L. Guest, M. John Gill, Daniela Garone, James Ndirangu, Kathrin Ehren, Colin Campbell, Robert S. Hogg, Matthew P. Fox, Olivia Keiser, Jonathan A C Sterne, Heidi M. Crane, Amy C. Justice, Michael S. Saag, Antonella Castagna, Dominique Costagliola, Michael Schomaker, Janet Giddy, Suzanne M Ingle, Fiona C Lampe, Andrew Boulle, Peter Reiss, Bryan E. Shepherd, François Dabis, Margaret T May, Matthias Egger |
| المساهمون: | Boulle, Andrew, Schomaker, Michael, May, Margaret T., Hogg, Robert S., Shepherd, Bryan E., Monge, Susana, Keiser, Olivia, Lampe, Fiona C., Giddy, Janet, Ndirangu, Jame, Garone, Daniela, Fox, Matthew, Ingle, Suzanne M., Reiss, Peter, Dabis, Francoi, Costagliola, Dominique, Castagna, Antonella, Ehren, Kathrin, Campbell, Colin, Gill, M. John, Saag, Michael, Justice, Amy C., Guest, Jodie, Crane, Heidi M., Egger, Matthia, Sterne, Jonathan A. C., Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, Department of Public Health and Family Medicine, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health |
| المصدر: | PLOS Medicince PLOS MEDICINE PLoS Medicine, Vol 11, Iss 9, p e1001718 (2014) PLoS Medicine e1001718-177 PLoS medicine, 11(9). Public Library of Science Boulle, A, Schomaker, M, May, M T, Hogg, R S, Shepherd, B E, Monge, S, Keiser, O, Lampe, F C, Giddy, J, Ndirangu, J, Garone, D, Fox, M, Ingle, S M, Reiss, P, Dabis, F, Costagliola, D, Castagna, A, Ehren, K, Campbell, C, Gill, M J, Saag, M, Justice, A C, Guest, J, Crane, H M, Egger, M & Sterne, J A C 2014, ' Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America : A Collaborative Analysis of Prospective Studies ', PLoS Medicine, vol. 11, no. 9, e1001718 . https://doi.org/10.1371/journal.pmed.1001718Test Repisalud Instituto de Salud Carlos III (ISCIII) Boulle, Andrew; Schomaker, Michael; May, Margaret T; Hogg, Robert S; Shepherd, Bryan E; Monge, Susana; Keiser, Olivia; Lampe, Fiona C; Giddy, Janet; Ndirangu, James; Garone, Daniela; Fox, Matthew; Ingle, Suzanne M; Reiss, Peter; Dabis, Francois; Costagliola, Dominique; Castagna, Antonella; Ehren, Kathrin; Campbell, Colin; Gill, M John; ... (2014). Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies. PLoS medicine, 11(9), e1001718. Public Library of Science 10.1371/journal.pmed.1001718 <http://dx.doi.org/10.1371/journal.pmed.1001718Test> |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Male, Viral Diseases, Epidemiology, lcsh:Medicine, HIV Infections, Plant Science, Global Health, Biochemistry, Cohort Studies, South Africa, Antiretroviral Therapy, Highly Active, Case fatality rate, Medicine and Health Sciences, Medicine, Public and Occupational Health, Viral load, HIV Infection, Prospective Studies, Cooperative Behavior, education.field_of_study, Death rates, Mortality rate, General Medicine, Middle Aged, Antiretroviral therapy, 3. Good health, AIDS, Europe, Infectious Diseases, Cohort, Female, Developed country, Research Article, Human, Biotechnology, Cohort study, Adult, Anti-HIV Agents, Population, Sexually Transmitted Diseases, Developing country, 610 Medicine & health, Infectious Disease Epidemiology, Follow-Up Studie, Acquired immunodeficiency syndrome (AIDS), 360 Social problems & social services, parasitic diseases, Humans, Mortality, education, Molecular Biology, business.industry, lcsh:R, Biology and Life Sciences, HIV, Anti-HIV Agent, Cell Biology, Plant Pathology, medicine.disease, Social Epidemiology, Prospective Studie, North America, HIV-1, Cohort Studie, business, Follow-Up Studies, Demography |
| الوصف: | Analyzing survival in HIV treatment cohorts, Andrew Boulle and colleagues find mortality rates in South Africa comparable to or better than those in North America by 4 years after starting antiretroviral therapy. Please see later in the article for the Editors' Summary Background High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. Methods and Findings Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0–3, 3–6, 6–12, 12–24, and 24–48 months on ART for the period 2001–2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count Editors' Summary Background AIDS has killed about 36 million people since the first recorded case of the disease in 1981, and a similar number of people (including 25 million living in sub-Saharan Africa) are currently infected with HIV, the virus that causes AIDS. HIV destroys immune system cells (including CD4 cells, a type of lymphocyte), leaving infected individuals susceptible to other serious infections. Early in the AIDS epidemic, HIV-positive people usually died within 10 years of becoming infected. In 1996, effective antiretroviral therapy (ART) became available and, for people living in high-income countries, HIV infection became a chronic condition. But ART was expensive, so HIV/AIDS remained largely untreated and fatal in resource-limited countries. Then, in 2003, the international community began to work towards achieving universal access to ART. By the end of 2012, nearly two-thirds of HIV-positive people (nearly 10 million individuals) living in low- and middle-income countries who were eligible for treatment because their CD4 cell count had fallen below 350/mm3 blood or because they had developed an AIDS-defining condition were receiving treatment. Why Was This Study Done? It is known that a larger proportion of HIV-positive patients starting ART die during the first year of treatment in sub-Saharan Africa than in Europe and North America. This difference arises in part because patients in resource-limited settings tend to have lower CD4 counts when they start treatment than patients in wealthy countries. However, the lack of reliable data on mortality (death) in resource-limited settings has made it hard to compare longer-term outcomes in different settings. Information on the long-term outcomes of HIV-positive patients receiving ART in resource-limited countries is needed to guide the development of appropriate health systems and treatment regimens in these settings. In this collaborative analysis of prospective cohort studies, the researchers compare mortality up to 4 years on ART in South Africa, Europe, and North America. A prospective cohort study follows a group of individuals over time to see whether differences in specific characteristics at the start of the study affect subsequent outcomes. A collaborative analysis combines individual patient data from several studies. What Did the Researchers Do and Find? The researchers combined data from four South Africa cohorts of HIV-positive patients starting ART included in the International Epidemiologic Databases to Evaluate AIDS South African (IeDEA-SA) collaboration with data from six North American cohorts and nine European cohorts included in the ART Cohort Collaboration (ART-CC). The South African cohorts were chosen because unusually for studies undertaken in countries in sub-Saharan Africa the vital status of patients (whether they had died) who had been lost to follow-up in these cohorts could be obtained from the national population register. Patients in South Africa began treatment with more advanced disease (indicated by a lower average CD4 count) than patients in Europe or North America. Notably, high early mortality after starting ART in South Africa occurred mainly in patients starting ART with a CD4 count below 50 cells/mm3. The cumulative mortality after 4 years of ART was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. After adjusting for patient characteristics at ART initiation, the mortality rate among patients beginning ART was initially lower in Europe and North American than in South Africa. However, although the adjusted mortality rate in Europe remained lower than the rate in South Africa, the rate in North America was higher than that in South Africa between 24 and 48 months on ART. What Do These Findings Mean? Although the linkage to national vital registration systems (databases of births and deaths) undertaken in this collaborative analysis is likely to have greatly reduced bias due to under-ascertainment of mortality, the accuracy of these findings may still be limited by differences in how this linkage was undertaken in different settings. Nevertheless, these findings suggest that mortality among HIV-infected patients receiving ART in South Africa, although initially higher than in Europe and North America, rapidly declines with increasing duration on ART and, after 4 years of treatment, approaches the rate seen in high-income settings. Intriguingly, these findings also highlight the relatively higher late mortality in North America compared to either Europe or South Africa, a result that needs to be investigated to explore the extent to which differences in mortality ascertainment, patient characteristics and comorbidities, or health systems and treatment regimens contribute to variations in outcomes among HIV-positive patients in various settings. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001718Test. This study is further discussed in a PLOS Medicine Perspective by Agnes Binagwaho and colleagues Information is available from the US National Institute of Allergy and Infectious Diseases on HIV infection and AIDS NAM/aidsmap provides basic information about HIV/AIDS, and summaries of recent research findings on HIV care and treatment Information is available from Avert, an international AIDS charity, on many aspects of HIV/AIDS, including information on universal access to ART, on HIV and AIDS in sub-Saharan Africa, and on HIV and AIDS in South Africa (in English and Spanish) The World Health Organization provides information on all aspects of HIV/AIDS (in several languages); its 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infections: recommendations for a public health approach are available The 2013 UNAIDS World AIDS Day Report provides up-to-date information about the AIDS epidemic and efforts to halt it Information about the International Epidemiologic Databases to Evaluate AIDS South African (IeDEA-SA) collaboration and about the ART Cohort Collaboration is available Personal stories about living with HIV/AIDS are available through Avert, Nam/aidsmap, and Healthtalkonline |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1549-1277 |
| DOI: | 10.1371/journal.pmed.1001718 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4798ad95fa925300f832f1a41576b82cTest https://doi.org/10.1371/journal.pmed.1001718Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....4798ad95fa925300f832f1a41576b82c |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15491277 |
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| DOI: | 10.1371/journal.pmed.1001718 |