Non-AIDS-defining events among HIV-1-infected adults receiving combination antiretroviral therapy in resource-replete versus resource-limited urban setting.

Wester CW, Koethe JR, Shepherd BE, Stinnette SE, Rebeiro PF, Kipp AM, Hong H, Bussmann H, Gaolathe T, McGowan CC, Sterling TR, Marlink RG
AIDS. 2011 25 (12): 1471-9

PMID: 21572309 · PMCID: PMC3188442 · DOI:10.1097/QAD.0b013e328347f9d4

OBJECTIVE - To compare incidence and distribution of non-AIDS-defining events (NADEs) among HIV-1-infected adults receiving combination antiretroviral therapy (cART) in urban sub-Saharan African versus United States settings.

DESIGN - Retrospective cohort analysis of clinical trial and observational data.

METHODS - Compared crude and standardized (to US cohort by age and sex) NADE rates from two urban adult HIV-infected cART-initiating populations: a clinical trial cohort in Gaborone, Botswana (Botswana) and an observational cohort in Nashville, Tennessee (USA).

RESULTS - Crude NADE incidence rates were similar: 10.0 [95% confidence interval 6.3-15.9] per 1000 person-years in Botswana versus 12.4 [8.4-18.4] per 1000 person-years in the United States. However, after standardizing to an older, predominantly male US population, the overall NADE incidence rates were higher in Botswana [18.7 (8.3-33.1) per 1000 person-years]. Standardized rates differed most for cardiovascular events (8.4 versus 5.0 per 1000 person-years) and non-AIDS-defining malignancies (8.0 versus 0.5 per 1000 person-years) - both higher in Botswana. Conversely, hepatic NADE rates were higher in the United States (4.0 versus 0.0 per 1000 person-years), whereas renal NADE rates [3.0 per 1000 person-years (United States) versus 2.4 per 1000 person-years (Botswana)] were comparable.

CONCLUSION - Crude NADE incidence rates were similar between cART-treated patients in a US observational cohort and a sub-Saharan African clinical trial. However, when standardized to the US cohort, overall NADE rates were higher in Botswana. NADEs appear to be a significant problem in our sub-Saharan African setting, and the monitoring, prevention, and treatment of NADEs should be a critical component of care in resource-limited settings.

MeSH Terms (20)

Adult Anti-Retroviral Agents Botswana CD4 Lymphocyte Count Cohort Studies Disease Progression Drug Therapy, Combination Female Health Services Accessibility HIV-1 HIV Infections Humans Incidence Male Retrospective Studies Risk Factors Tennessee Urban Health Viral Load Virus Replication

Connections (2)

This publication is referenced by other Labnodes entities:

Links