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11 results on '"Schomaker, Michael"'

1. CD4 count at antiretroviral therapy initiation and the risk of loss to follow-up: results from a multicentre cohort study.

Author

Grimsrud A, Cornell M, Schomaker M, Fox MP, Orrell C, Prozesky H, Stinson K, Tanser F, Egger M, and Myer L

Subjects
Adult, Cohort Studies, Continuity of Patient Care, Female, HIV Infections blood, HIV Infections epidemiology, Humans, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Risk, South Africa epidemiology, Treatment Outcome, Viral Load drug effects, Anti-Retroviral Agents therapeutic use, CD4 Lymphocyte Count statistics & numerical data, HIV Infections drug therapy, Lost to Follow-Up
Abstract

Background: Antiretroviral therapy (ART) initiation is now recommended irrespective of CD4 count. However data on the relationship between CD4 count at ART initiation and loss to follow-up (LTFU) are limited and conflicting., Methods: We conducted a cohort analysis including all adults initiating ART (2008-2012) at three public sector sites in South Africa. LTFU was defined as no visit in the 6 months before database closure. The Kaplan-Meier estimator and Cox's proportional hazards models examined the relationship between CD4 count at ART initiation and 24-month LTFU. Final models were adjusted for demographics, year of ART initiation, programme expansion and corrected for unascertained mortality., Results: Among 17 038 patients, the median CD4 at initiation increased from 119 (IQR 54-180) in 2008 to 257 (IQR 175-318) in 2012. In unadjusted models, observed LTFU was associated with both CD4 counts <100 cells/μL and CD4 counts ≥300 cells/μL. After adjustment, patients with CD4 counts ≥300 cells/μL were 1.35 (95% CI 1.12 to 1.63) times as likely to be LTFU after 24 months compared to those with a CD4 150-199 cells/μL. This increased risk for patients with CD4 counts ≥300 cells/μL was largest in the first 3 months on treatment. Correction for unascertained deaths attenuated the association between CD4 counts <100 cells/μL and LTFU while the association between CD4 counts ≥300 cells/μL and LTFU persisted., Conclusions: Patients initiating ART at higher CD4 counts may be at increased risk for LTFU. With programmes initiating patients at higher CD4 counts, models of ART delivery need to be reoriented to support long-term retention., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Published
2016
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2. When to start antiretroviral therapy in children aged 2-5 years: a collaborative causal modelling analysis of cohort studies from southern Africa.

Author

Schomaker M, Egger M, Ndirangu J, Phiri S, Moultrie H, Technau K, Cox V, Giddy J, Chimbetete C, Wood R, Gsponer T, Bolton Moore C, Rabie H, Eley B, Muhe L, Penazzato M, Essajee S, Keiser O, and Davies MA

Subjects
Africa, Southern, Anti-HIV Agents therapeutic use, Child, Preschool, Cohort Studies, Cooperative Behavior, Disease Progression, Drug Administration Schedule, Humans, Models, Biological, Anti-HIV Agents administration & dosage, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV Infections drug therapy
Abstract

Background: There is limited evidence on the optimal timing of antiretroviral therapy (ART) initiation in children 2-5 y of age. We conducted a causal modelling analysis using the International Epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaborative dataset to determine the difference in mortality when starting ART in children aged 2-5 y immediately (irrespective of CD4 criteria), as recommended in the World Health Organization (WHO) 2013 guidelines, compared to deferring to lower CD4 thresholds, for example, the WHO 2010 recommended threshold of CD4 count <750 cells/mm(3) or CD4 percentage (CD4%) <25%., Methods and Findings: ART-naïve children enrolling in HIV care at IeDEA-SA sites who were between 24 and 59 mo of age at first visit and with ≥1 visit prior to ART initiation and ≥1 follow-up visit were included. We estimated mortality for ART initiation at different CD4 thresholds for up to 3 y using g-computation, adjusting for measured time-dependent confounding of CD4 percent, CD4 count, and weight-for-age z-score. Confidence intervals were constructed using bootstrapping. The median (first; third quartile) age at first visit of 2,934 children (51% male) included in the analysis was 3.3 y (2.6; 4.1), with a median (first; third quartile) CD4 count of 592 cells/mm(3) (356; 895) and median (first; third quartile) CD4% of 16% (10%; 23%). The estimated cumulative mortality after 3 y for ART initiation at different CD4 thresholds ranged from 3.4% (95% CI: 2.1-6.5) (no ART) to 2.1% (95% CI: 1.3%-3.5%) (ART irrespective of CD4 value). Estimated mortality was overall higher when initiating ART at lower CD4 values or not at all. There was no mortality difference between starting ART immediately, irrespective of CD4 value, and ART initiation at the WHO 2010 recommended threshold of CD4 count <750 cells/mm(3) or CD4% <25%, with mortality estimates of 2.1% (95% CI: 1.3%-3.5%) and 2.2% (95% CI: 1.4%-3.5%) after 3 y, respectively. The analysis was limited by loss to follow-up and the unavailability of WHO staging data., Conclusions: The results indicate no mortality difference for up to 3 y between ART initiation irrespective of CD4 value and ART initiation at a threshold of CD4 count <750 cells/mm(3) or CD4% <25%, but there are overall higher point estimates for mortality when ART is initiated at lower CD4 values. Please see later in the article for the Editors' Summary.

Published
2013
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3. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

Author

Judd, Ali, Zangerle, Robert, Touloumi, Giota, Warszawski, Josiane, Meyer, Laurence, Dabis, François, Krause, Murielle Mary, Ghosn, Jade, Leport, Catherine, Wittkop, Linda, Reiss, Peter, Wit, Ferdinand, Prins, Maria, Bucher, Heiner, Gibb, Diana, Fätkenheuer, Gerd, Julia, Del Amo, Obel, Niels, Thorne, Claire, Mocroft, Amanda, Kirk, Ole, Stephan, Christoph, Pérez-Hoyos, Santiago, Hamouda, Osamah, Bartmeyer, Barbara, Chkhartishvili, Nikoloz, Noguera-Julian, Antoni, Antinori, Andrea, Monforte, Antonella d’Arminio, Brockmeyer, Norbert, Prieto, Luis, Conejo, Pablo Rojo, Soriano-Arandes, Antoni, Battegay, Manuel, Kouyos, Roger, Mussini, Cristina, Tookey, Pat, Casabona, Jordi, Miró, Jose M, Castagna, Antonella, Konopnick, Deborah, Goetghebuer, Tessa, Sönnerborg, Anders, Quiros-Roldan, Eugenia, Sabin, Caroline, Teira, Ramon, Garrido, Myriam, Haerry, David, de Wit, Stéphane, Costagliola, Dominique, d’Arminio-Monforte, Antonella, del Amo, Julia, Raben, Dorthe, Chêne, Geneviève, Rojo, Conejo Pablo, Barger, Diana, Schwimmer, Christine, Termote, Monique, Campbell, Maria, Frederiksen, Casper M, Friis-Møller, Nina, Kjaer, Jesper, Brandt, Rikke Salbøl, Berenguer, Juan, Bohlius, Julia, Bouteloup, Vincent, Cozzi-Lepri, Alessandro, Davies, Mary-Anne, Dorrucci, Maria, Dunn, David, Egger, Matthias, Furrer, Hansjakob, Grabar, Sophie, Guiguet, Marguerite, Lambotte, Olivier, Leroy, Valériane, Lodi, Sara, Matheron, Sophie, Miro, Jose M, Monge, Susana, Nakagawa, Fumiyo, Paredes, Roger, Phillips, Andrew, Puoti, Massimo, Rohner, Eliane, and Schomaker, Michael

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Sexually Transmitted Infections, Rare Diseases, Emerging Infectious Diseases, Infectious Diseases, HIV/AIDS, Infection, Adolescent, Adult, Anti-Retroviral Agents, CD4 Lymphocyte Count, Cohort Studies, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Risk Factors, Sarcoma, Kaposi, Viral Load, Young Adult, AIDS-defining Cancer Project Working Group for IeDEA and COHERE in EuroCoord, HIV, Kaposi sarcoma, antiretroviral therapy, cohort study, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

BackgroundWe compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.MethodsWe 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).ResultsWe included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 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/µL with those whose counts were

Published
2017

4. Virologic non‐suppression and early loss to follow up among pregnant and non‐pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study.

Author

Nyakato, Patience, Schomaker, Michael, Fatti, Geoffrey, Tanser, Frank, Euvrard, Jonathan, Sipambo, Nosisa, Fox, Matthew P., Haas, Andreas D., Yiannoutsos, Constantin T., Davies, Mary‐Ann, and Cornell, Morna

Subjects
*ANTIRETROVIRAL agents, *TEENAGERS, *COHORT analysis, *TEENAGE girls, *CD4 lymphocyte count
Abstract

Introduction: Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods: We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results: We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions: Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified. [ABSTRACT FROM AUTHOR]

Published
2022
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5. Immunological and virological response to antiretroviral treatment in migrant and native men and women in Western Europe; is benefit equal for all?

Author

Monge, S., Mocroft, A., Sabin, A., Touloumi, G., Sighem, A., Abgrall, S., Dray-Spira, R., Spire, B., Castagna, A., Mussini, C., Zangerle, R., Hessamfar, M., Anderson, J., Hamouda, O., Ehren, K., Obel, N., Kirk, O., Antinori, A., Girardi, E., Saracino, A., Calmy, A., Wit, S., Wittkop, L., Bucher, C., Montoliu, A., Raben, D., Prins, M., Meyer, L., Chene, G., Burns, F., Amo, J., Judd, Ali, Zangerle, Robert, Touloumi, Giota, Warszawski, Josiane, Meyer, Laurence, Dabis, François, Krause, Murielle, Ghosn, Jade, Leport, Catherine, Wittkop, Linda, Reiss, Peter, Wit, Ferdinand, Prins, Maria, Bucher, Heiner, Gibb, Diana, Fätkenheuer, Gerd, Amo, Julia, Obel, Niels, Thorne, Claire, Mocroft, Amanda, Kirk, Ole, Stephan, Christoph, Pérez-Hoyos, Santiago, Bartmeyer, Barbara, Chkhartishvili, Nikoloz, Noguera-Julian, Antoni, Antinori, Andrea, Monforte, Antonella, Brockmeyer, Norbert, Prieto, Luis, Conejo, Pablo, Soriano-Arandes, Antoni, Battegay, Manuel, Kouyos, Roger, Mussini, Cristina, Tookey, Pat, Casabona, Jordi, Miró, Josem, Castagna, Antonella, Konopnick, Deborah, Goetghebuer, Tessa, Sönnerborg, Anders, Torti, Carlo, Sabin, Caroline, Teira, Ramon, Garrido, Myriam, Haerry, David, Wit, Stéphane, Miró, M., Costagliola, Dominique, d'Arminio-Monforte, Antonella, Raben, Dorthe, Chêne, Geneviève, Barger, Diana, Schwimmer, Christine, Termote, Monique, Campbell, Maria, Frederiksen, Casper M, Friis-Møller, Nina, Kjaer, Jesper, Brandt, Rikke, Berenguer, Juan, Bohlius, Julia, Bouteloup, Vincent, Cozzi-Lepri, Alessandro, Davies, Mary-Anne, Dorrucci, Maria, Dunn, David, Egger, Matthias, Furrer, Hansjakob, Guiguet, Marguerite, Grabar, Sophie, Lambotte, Olivier, Leroy, Valériane, Lodi, Sara, Matheron, Sophie, Miró, Jose, Monge, Susana, Nakagawa, Fumiyo, Paredes, Roger, Phillips, Andrew, Puoti, Massimo, Rohner, Eliane, Schomaker, Michael, Smit, Colette, Sterne, Jonathan, Thiebaut, Rodolphe, Valk, Marc, Migrant Health Working Group for the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in, Eurocoord, Castagna, Antonella, AII - Infectious diseases, APH - Global Health, Infectious diseases, APH - Aging & Later Life, Global Health, Monge, S, Mocroft, A, Sabin, A, Touloumi, G, Sighem, A, Abgrall, S, Dray-Spira, R, Spire, B, Castagna, A, Mussini, C, Zangerle, R, Hessamfar, M, Anderson, J, Hamouda, O, Ehren, K, Obel, N, Kirk, O, Antinori, A, Girardi, E, Saracino, A, Calmy, A, Wit, S, Wittkop, L, Bucher, C, Montoliu, A, Raben, D, Prins, M, Meyer, L, Chene, G, Burns, F, Amo, J, Judd, A, Warszawski, J, Dabis, F, Krause, M, Ghosn, J, Leport, C, Reiss, P, Wit, F, Bucher, H, Gibb, D, Fatkenheuer, G, Thorne, C, Stephan, C, Perez-Hoyos, S, Bartmeyer, B, Chkhartishvili, N, Noguera-Julian, A, Monforte, A, Brockmeyer, N, Prieto, L, Conejo, P, Soriano-Arandes, A, Battegay, M, Kouyos, R, Tookey, P, Casabona, J, Miro, J, Konopnick, D, Goetghebuer, T, Sonnerborg, A, Torti, C, Sabin, C, Teira, R, Garrido, M, Haerry, D, Miro, M, Costagliola, D, d'Arminio-Monforte, A, Barger, D, Schwimmer, C, Termote, M, Campbell, M, Frederiksen, C, Friis-Moller, N, Kjaer, J, Brandt, R, Berenguer, J, Bohlius, J, Bouteloup, V, Cozzi-Lepri, A, Davies, M, Dorrucci, M, Dunn, D, Egger, M, Furrer, H, Guiguet, M, Grabar, S, Lambotte, O, Leroy, V, Lodi, S, Matheron, S, Nakagawa, F, Paredes, R, Phillips, A, Puoti, M, Rohner, E, Schomaker, M, Smit, C, Sterne, J, Thiebaut, R, and Valk, M

Subjects
Male, 0301 basic medicine, Latin Americans, HIV Infections, migrants, Anti-Retroviral Agents/therapeutic use, Cohort Studies, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, Epidemiology, Pharmacology (medical), 030212 general & internal medicine, Immunovirological response, Young adult, ddc:616, Transients and Migrants, Health Policy, virus diseases, Middle Aged, Viral Load, 3. Good health, Europe, combination antiretroviral therapy, HIV, immunovirological response, sex, Infectious Diseases, Treatment Outcome, Anti-Retroviral Agents, RNA, Viral, Female, Sex, Viral load, Cohort study, Adult, Cart, Combination antiretroviral therapy, medicine.medical_specialty, Adolescent, HIV Infections/drug therapy, Young Adult, 03 medical and health sciences, Population Groups, medicine, Humans, RNA, Viral/blood, Aged, business.industry, Migrant, 030112 virology, Confidence interval, CD4 Lymphocyte Count, migrant, Institutional repository, Immunology, business, Demography
Abstract

Objectives: The aim of the study was to evaluate differences in immunovirological response to combination antiretroviral therapy (cART) in migrant and native men and women within a European collaboration of HIV cohorts Collaboration of Observational HIV Epidemiological Research in Europ (COHERE) in EuroCoord, 2004-2013. Methods: Migrants were defined as those with geographical origin (GO) different from the reporting country and were grouped as originating from Western Europe and Western Countries (WEWC), Eastern Europe (EE), North Africa and the Middle East (NAME), sub-Saharan Africa (SSA), Latin America (LA), Caribbean (CRB) and Asia/Oceania (ASIA/OCE). Native (NAT) individuals were defined as those originating from the reporting country. CD4 cell counts were modelled using piecewise linear mixed-effects models with two slopes, whereas models to estimate subdistribution hazard ratios (sHRs) were used for time to virological response (VR) (i.e. time from cART initiation to the first of two successive HIV RNA measurements < 400 HIV-1 RNA copies/ml). Results: Of 32 817 individuals, 25 799 (78.6%) were men. The percentage of migrants was higher in women (48.9%) than in men (21.2%) and migrants from SSA accounted for the largest migrant group (29.9% in men and 63.3% in women). Migrant men and women from SSA started at lower CD4 cell counts than NAT individuals, which remained lower over time. VR was ≥ 85% at 12 months for all groups except CRB women (77.7%). Compared with NAT men and women, lower VR was experienced by NAME [sHR 0.91; 95% confidence interval (CI) 0.86-0.97] and SSA (sHR 0.88; 95% CI 0.82-0.95) men and CRB (sHR 0.77; 85% CI 0.67-0.89) women, respectively. Conclusions: Immunovirological response to cART in Western Europe varies by GO and sex of patients. ART benefits are not equal for all, underlining the point that efforts need to prioritize those most in need.

Published
2018

6. CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: A multinational, multicohort European study

Author

Wittkop, Linda, Arsandaux, Julie, Trevino, Ana, van der Loeff, Maarten Schim, Anderson, Jane, van Sighem, Ard, Böni, Jürg, Brun-Vezinet, Françoise, Soriano, Vicente, Boufassa, Faroudy, Brockmeyer, Norbert, Calmy, Alexandra, Dabis, François, Jarrin, Inma, Dorrucci, Maria, Duque, Vitor, Fätkenheuer, Gerd, Zangerle, Robert, Ferrer, Elena, Porter, Kholoud, Judd, Ali, Sipsas, Nikolaos V., Lambotte, Olivier, Shepherd, Leah, Leport, Catherine, Morrison, Charles, Mussini, Cristina, Obel, Niels, Ruelle, Jean, Schwarze-Zander, Carolyne, Sonnerborg, Anders, Teira, Ramon, Torti, Carlo, Valadas, Emilia, Colin, Celine, Friis-Møller, Nina, Costagliola, Dominique, Thiebaut, Rodolphe, Chene, Geneviève, Matheron, Sophie, Touloumi, Giota, Warszawski, Josiane, Meyer, Laurence, Krause, Murielle Mary, Ghosn, Jade, Reiss, Peter, Wit, Ferdinand, Prins, Maria, Bucher, Heiner, Gibb, Diana, Del Amo, Julia, Thorne, Claire, Mocroft, Amanda, Kirk, Ole, Stephan, Christoph, Pérez-Hoyos, Santiago, Hamouda, Osamah, Bartmeyer, Barbara, Chkhartishvili, Nikoloz, Noguera-Julian, Antoni, Antinori, Andrea, Monforte, Antonella d'Arminio, Prieto, Luis, Conejo, Pablo Rojo, Soriano-Arandes, Antoni, Battegay, Manuel, Kouyos, Roger, Tookey, Pat, Casabona, Jordi, Mirò, Jose M., Castagna, Antonella, Konopnick, Deborah, Goetghebuer, Tessa, Sönnerborg, Anders, Sabin, Caroline, Garrido, Myriam, Haerry, David, Berenguer, Juan, Bohlius, Julia, Bouteloup, Vincent, Cozzi-Lepri, Alessandro, Davies, Mary-Anne, Amo, Julia del, Dunn, David, Egger, Matthias, Furrer, Hansjakob, Guiguet, Marguerite, Grabar, Sophie, Leroy, Valériane, Lodi, Sara, Monge, Susana, Nakagawa, Fumiyo, Paredes, Roger, Phillips, Andrew, Puoti, Massimo, Schomaker, Michael, Smit, Colette, Sterne, Jonathan, van der Valk, Marc, Wyss, Natasha, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale (INSERM), Team MORPH3EUS (INSERM U1219 - UB - ISPED), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Infectious Diseases, Hospital Carlos III, Center for Infection and Immunity Amsterdam - CINIMA [Amsterdam, The Netherlands], Homerton University Hospital, Stichting HIV Monitoring [Amsterdam], Universiteit van Amsterdam (UvA), Universität Zürich [Zürich] = University of Zurich (UZH), Université Paris Diderot - Paris 7 (UPD7), Service de Virologie [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Ruhr-Universität Bochum [Bochum], Geneva University Hospital (HUG), CHU de Bordeaux Pellegrin [Bordeaux], Instituto de Salud Carlos III [Madrid] (ISC), CIBER de Epidemiología y Salud Pública (CIBERESP), Istituto Superiore di Sanità (ISS), Hospitais da Universidade de Coimbra (H.U.C.), University of Coimbra [Portugal] (UC), University Hospital of Cologne [Cologne], Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), Hospitalet de Llobregat, University College of London [London] (UCL), National and Kapodistrian University of Athens (NKUA), Service de Médecine Interne et Immunologie clinique [AP-HP Hôpital Bicêtre], Hôpital Bicêtre, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), FHI 360, Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia (UNIMORE), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Université Catholique de Louvain = Catholic University of Louvain (UCL), University Hospital Bonn, Department of Infectious Diseases, Institution of Medicine, Karolinska University Hospital and Karolinska Institutet, Sierrallana Hospital, Università degli Studi 'Magna Graecia' di Catanzaro = University of Catanzaro (UMG), Universidade de Lisboa = University of Lisbon (ULISBOA), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Infectious diseases, Wittkop, L, Arsandaux, J, Trevino, A, van der Loeff, M, Anderson, J, van Sighem, A, Böni, J, Brun-Vezinet, F, Soriano, V, Boufassa, F, Brockmeyer, N, Calmy, A, Dabis, F, Jarrin, I, Dorrucci, M, Duque, V, Fätkenheuer, G, Zangerle, R, Ferrer, E, Porter, K, Judd, A, Sipsas, N, Lambotte, O, Shepherd, L, Leport, C, Morrison, C, Mussini, C, Obel, N, Ruelle, J, Schwarze-Zander, C, Sonnerborg, A, Teira, R, Torti, C, Valadas, E, Colin, C, Friis-Møller, N, Costagliola, D, Thiebaut, R, Chene, G, Matheron, S, Touloumi, G, Warszawski, J, Meyer, L, Krause, M, Ghosn, J, Reiss, P, Wit, F, Prins, M, Bucher, H, Gibb, D, Del Amo, J, Thorne, C, Mocroft, A, Kirk, O, Stephan, C, Pérez-Hoyos, S, Hamouda, O, Bartmeyer, B, Chkhartishvili, N, Noguera-Julian, A, Antinori, A, Monforte, A, Prieto, L, Conejo, P, Soriano-Arandes, A, Battegay, M, Kouyos, R, Tookey, P, Casabona, J, Mirò, J, Castagna, A, Konopnick, D, Goetghebuer, T, Sönnerborg, A, Sabin, C, Garrido, M, Haerry, D, Berenguer, J, Bohlius, J, Bouteloup, V, Cozzi-Lepri, A, Davies, M, Amo, J, Dunn, D, Egger, M, Furrer, H, Guiguet, M, Grabar, S, Leroy, V, Lodi, S, Monge, S, Nakagawa, F, Paredes, R, Phillips, A, Puoti, M, Schomaker, M, Smit, C, Sterne, J, van der Valk, M, Wyss, N, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Istituto Superiore di Sanita [Rome], Gestionnaire, Hal Sorbonne Université, Wittkop, Linda, Arsandaux, Julie, Trevino, Ana, Van Der Loeff V Schim, Maarten, Anderson, Jane, Van Sighem, Ard, Jurg, Boni, Brun-Vezinet, Francoise, Soriano, Vicente, Boufassa, Faroudy, Brockmeyer, Norbert, Calmy, Alexandra, Dabis, Francoi, Jarrin, Inma, Dorrucci, Maria, Duque, Vitor, Fãtkenheuer, Gerd, Zangerle, Robert, Ferrer, Elena, Porter, Kholoud, Judd, Ali, Sipsas, Nikolaos V, Lambotte, Olivier, Shepherd, Leah, Leport, Catherine, Morrison, Charle, Mussini, Cristina, Obel, Niel, Ruelle, Jean, Schwarze-Zander, Carolyne, Sonnerborg, Ander, Teira, Ramon, Torti, Carlo, Valadas, Emilia, Colin, Celine, Friis-Moller, Nina, Costagliola, Dominique, Thiebaut, Rodolphe, Chene, Geneviève, Matheron, Sophie, on behalf of the COHERE in EuroCoord and ACHIeV2e Study, Group, and Castagna, Antonella

Subjects
0301 basic medicine, CD4-Positive T-Lymphocytes, Male, Internationality, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Gastroenterology, Anti-HIV Agents/administration & dosage/adverse effects/therapeutic use, Viral/blood, Cohort Studies, 0302 clinical medicine, CD4 HIV, Pharmacology (medical), 030212 general & internal medicine, Cd4 cell count, ddc:616, Confounding, virus diseases, Middle Aged, Viral Load, 3. Good health, [SDV] Life Sciences [q-bio], Europe, HIV-2/drug effects, Infectious Diseases, HIV-1/drug effects, RNA, Viral, Female, Viral load, Cohort study, Microbiology (medical), Cart, Adult, medicine.medical_specialty, Anti-HIV Agents, 030106 microbiology, 03 medical and health sciences, Internal medicine, medicine, Humans, Pharmacology, business.industry, CD4-Positive T-Lymphocytes/immunology/virology, CD4 Lymphocyte Count, Institutional repository, HIV Infections/blood/drug therapy/immunology/virology, HIV-2, HIV-1, RNA, Panton–Valentine leukocidin, business
Abstract

Background: CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL). Methods: ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models. Results: We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36-52) and 37 years (IQR 31-44), respectively. Median observed pretreatment CD4 cell counts/mm(3) were 203 (95% CI 100-290) in HIV-2+ patients and 223 (95% CI 100-353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12months were + 105 (95% CI 77-134) in HIV-2+ patients and + 202 (95% CI 199-205) in HIV-1+ patients, an observed difference of 97 cells/mm(3) in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm(3)/year lower (95% CI 5-44; P=0.0127) in HIV-2+ patients compared with HIV-1+ patients. Conclusions: A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2

Published
2017

7. Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers

Author

Chereau, Fanny, Madec, Yoann, Sabin, Caroline, Obel, Niels, Ruiz-Mateos, Ezequiel, Chrysos, Georgios, Fidler, Sarah, Lehmann, Clara, Zangerle, Robert, Wittkop, Linda, Reiss, Peter, Hamouda, Osamah, Perez, Vicente Estrada, Leal, Manuel, Mocroft, Amanda, De Olalla, Patricia Garcia, Ammassari, Adriana, Monforte, Antonella D'Arminio, Mussini, Cristina, Segura, Ferran, Castagna, Antonella, Cavassini, Matthias, Grabar, Sophie, Morlat, Philippe, De Wit, Stéphane, Lambotte, Olivier, Meyer, Laurence, Judd, Ali, Touloumi, Giota, Warszawski, Josiane, Dabis, François, Krause, Murielle Mary, Ghosn, Jade, Leport, Catherine, Wit, Ferdinand, Prins, Maria, Bucher, Heiner, Gibb, Diana, Fätkenheuer, Gerd, Del Amo, Julia, Thorne, Claire, Kirk, Ole, Stephan, Christoph, Pérez-Hoyos, Santiago, Bartmeyer, Barbara, Chkhartishvili, Nikoloz, Noguera-Julian, Antoni, Antinori, Andrea, Brockmeyer, Norbert, Prieto, Luis, Conejo, Pablo Rojo, Soriano-Arandes, Antoni, Battegay, Manuel, Kouyos, Roger, Tookey, Pat, Casabona, Jordi, Miró, Jose M., Konopnick, Deborah, Goetghebuer, Tessa, Sönnerborg, Anders, Torti, Carlo, Teira, Ramon, Garrido, Myriam, Haerry, David, Miró, Jose Ma, Costagliola, Dominique, D'Arminio-Monforte, Antonella, Raben, Dorthe, Chêne, Geneviève, Barger, Diana, Schwimmer, Christine, Termote, Monique, Campbell, Maria, Frederiksen, Casper M., Friis-Møller, Nina, Kjaer, Jesper, Brandt, Rikke Salbøl, Berenguer, Juan, Bohlius, Julia, Bouteloup, Vincent, Cozzi-Lepri, Alessandro, Davies, Mary-Anne, Dorrucci, Maria, Dunn, David, Egger, Matthias, Furrer, Hansjakob, Guiguet, Marguerite, Leroy, Valériane, Lodi, Sara, Matheron, Sophie, Monge, Susana, Nakagawa, Fumiyo, Paredes, Roger, Phillips, Andrew, Puoti, Massimo, Rohner, Eliane, Schomaker, Michael, Smit, Colette, Sterne, Jonathan, Thiebaut, Rodolphe, Van Der Valk, Marc, Fanny, C, Yoann, M, Caroline, S, Niels, O, Ezequiel, R, Georgios, C, Sarah, F, Clara, L, Robert, Z, Linda, W, Peter, R, Osamah, H, Vicente Estrada, P, Manuel, L, Amanda, M, Patricia Garcia De, O, Adriana, A, Antonella D’Arminio, M, Cristina, M, Ferran, S, Antonella, C, Matthias, C, Sophie, G, Philippe, M, Stéphane De, W, Olivier, L, Laurence, M, Puoti, M, Chereau, F, Madec, Y, Sabin, C, Obel, N, Ruiz-Mateos, E, Chrysos, G, Fidler, S, Lehmann, C, Zangerle, R, Wittkop, L, Reiss, P, Hamouda, O, Perez, Ve, Leal, M, Mocroft, A, De Olalla, Pg, Ammassari, A, Monforte, Ada, Mussini, C, Segura, F, Castagna, A, Cavassini, M, Grabar, S, Morlat, P, De Wit, S, Lambotte, O, Meyer, L, The HIV Controllers Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in, Eurocoord, Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (France), HIV Monitoring Foundation, Augustinus Foundation, European Commission, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), University College London Hospitals (UCLH), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Hospital Universitario Virgen del Rocío [Sevilla], Tzaneio General Hospital, Imperial College London, German Center for Infection Research - Partner Site Bonn-Cologne (DZIF), Universität Innsbruck [Innsbruck], Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Robert Koch Institute [Berlin] (RKI), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), CIBER de Epidemiología y Salud Pública (CIBERESP), Istituto Nazionale di Malattie Infettive 'Lazzaro Spallanzani' (INMI), University of Milan, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Hospital Universitari Parc Taulí of Sabadell, Barcelona, Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Université de Lausanne (UNIL), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université libre de Bruxelles (ULB), Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Università degli Studi di Milano = University of Milan (UNIMI), Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia (UNIMORE), Université de Lausanne = University of Lausanne (UNIL), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), HAL UPMC, Gestionnaire, AII - Infectious diseases, APH - Aging & Later Life, Global Health, Amsterdam institute for Infection and Immunity, HIV Controllers Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCOORD, Imperial College Healthcare NHS Trust- BRC Funding, and Medical Research Council (MRC)

Subjects
Male, HIV Infections, CD8-Positive T-Lymphocytes, Pathology and Laboratory Medicine, Immunodeficiency Viruses, HIV-1/immunology, Public and Occupational Health, lcsh:Science, Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Female, HIV-1, Humans, Viral Load, Viremia, Virus Replication, Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), virus diseases, CD8-Positive T-Lymphocytes/drug effects, Antiretroviral Therapy, Highly Active/methods, Medical Microbiology, Viral Pathogens, Science & Technology - Other Topics, Human, Blood cells, Immunology, HIV Infections/drug therapy, Virus Replication/immunology, Men WHO Have Sex with Men, Cytotoxic T cells, Microbiology, Viremia/drug therapy, Microbial Pathogens, Science & Technology, lcsh:R, Organisms, Biology and Life Sciences, Anti-HIV Agent, NATURAL-HISTORY, CD8-Positive T-Lymphocyte, Anti-HIV Agents/therapeutic use, HIV CD4 AIDS, T-CELLS, Population Groupings, lcsh:Q, Preventive Medicine, Sexuality Groupings, RNA viruses, RNA LEVELS, lcsh:Medicine, PROGRESSION, ACTIVATION, INFECTION, Cellular types, Medicine and Health Sciences, HIV Infection, Medicine (all), Immune cells, HIV diagnosis and management, ABSENCE, Vaccination and Immunization, Multidisciplinary Sciences, Infectious Diseases, CD4-Positive T-Lymphocyte, Viruses, White blood cells, Pathogens, Research Article, Cell biology, Evolutionary Immunology, Infectious Disease Control, General Science & Technology, T cells, Antiretroviral Therapy, CD4-Positive T-Lymphocytes/drug effects, CD4 Lymphocyte Count/methods, Viral Evolution, Antiviral Therapy, Virology, MD Multidisciplinary, Retroviruses, Evolutionary Biology, Lentivirus, HIV, Viral Load/drug effects, Diagnostic medicine, Organismal Evolution, Animal cells, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, REPLICATION, People and Places, Microbial Evolution, CD4-Positive T-Lymphocytes/immunology, CD4-Positive T-Lymphocytes/virology, CD8-Positive T-Lymphocytes/immunology, HIV Infections/immunology, HIV Infections/virology, Viral Load/immunology, Viremia/immunology, Viremia/virology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, INVERSE PROBABILITY
Abstract

[Objective] HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control., [Methods] HICs were identified in COHERE on the basis of ≥5 consecutive viral loads (VL) ≤500 copies/mL over ≥1 year whilst ART-naive, with the last VL ≤500 copies/mL measured ≥5 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models., [Results] We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds., [Discussion] Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs., The COHERE study group has received unrestricted funding from: Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS), France; HIV Monitoring Foundation, The Netherlands; and the Augustinus Foundation, Denmark. The research leading to these results received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement n° 260694.

Published
2017

8. Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat‐all approach in rural Eswatini.

Author

Kerschberger, Bernhard, Schomaker, Michael, Ciglenecki, Iza, Pasipamire, Lorraine, Mabhena, Edwin, Telnov, Alex, Rusch, Barbara, Lukhele, Nomthandazo, Teck, Roger, and Boulle, Andrew

Subjects
*PUBLIC sector, *CD4 lymphocyte count
Abstract

Objectives: To assess long‐term antiretroviral therapy (ART) outcomes during rapid HIV programme expansion in the public sector of Eswatini (formerly Swaziland). Methods: This is a retrospectively established cohort of HIV‐positive adults (≥16 years) who started first‐line ART in 25 health facilities in Shiselweni (Eswatini) between 01/2006 and 12/2014. Temporal trends in ART attrition, treatment expansion and ART coverage were described over 9 years. We used flexible parametric survival models to assess the relationship between time to ART attrition and covariates. Results: Of 24 772 ART initiations, 6% (n = 1488) occurred in 2006, vs. 13% (n = 3192) in 2014. Between these years, median CD4 cell count at ART initiation increased (113–265 cells/mm3). The active treatment cohort expanded 8.4‐fold, ART coverage increased 8.0‐fold (7.1% in 2006 vs. 56.8% in 2014) and 12‐month crude ART retention improved from 71% to 86%. Compared with the pre‐decentralisation period (2006–2007), attrition decreased by 5% (adjusted hazard ratio [aHR] 0.95, 95% confidence interval 0.88–1.02) during HIV‐TB service decentralisation (2008–2010), by 17% (aHR 0.83, 0.75–0.92) during service consolidation (2011–2012), and by 20% (aHR 0.80, 0.71–0.90) during further treatment expansion (2013–2014). The risk of attrition was higher for young age, male sex, pathological baseline haemoglobin and biochemistry results, more toxic drug regimens, WHO III/IV staging and low CD4 cell count; access to a telephone was protective. Conclusions: Programmatic outcomes improved during large expansion of the treatment cohort and increased ART coverage. Changes in ART programming may have contributed to better outcomes. [ABSTRACT FROM AUTHOR]

Published
2019
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9. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Author

Schomaker, Michael, Leroy, Valeriane, Wolfs, Tom, Technau, Karl-Günter, Renner, Lorna, Judd, Ali, Sawry, Shobna, Amorissani-Folquet, Madeleine, Noguera-Julian, Antoni, Tanser, Frank, Eboua, François, Navarro, Maria Luisa, Chimbetete, Cleophas, Amani-Bosse, Clarisse, Warszawski, Josiane, Phiri, Sam, N'Gbeche, Sylvie, Cox, Vivian, Koueta, Fla, and Giddy, Janet

Subjects
*ANTIRETROVIRAL agents, *HIV infections, *THERAPEUTICS, *HIV-positive youth, *HIV-positive children, *MEDICAL care of HIV-positive persons, *BODY weight, *COMPARATIVE studies, *DEMOGRAPHY, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *RESEARCH funding, *STATISTICS, *TIME, *DATA analysis, *EVALUATION research, *HIGHLY active antiretroviral therapy, *CD4 lymphocyte count
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. [ABSTRACT FROM AUTHOR]

Published
2017
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10. Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children Ages 1-5 Years: A Causal Modeling Analysis.

Author

Schomaker, Michael, Davies, Mary-Ann, Malateste, Karen, Renner, Lorna, Sawry, Shobna, N'Gbeche, Sylvie, Technau, Karl-Günter, Eboua, François, Tanser, Frank, Sygnaté-Sy, Haby, Phiri, Sam, Amorissani-Folquet, Madeleine, Cox, Vivian, Koueta, Fla, Chimbete, Cleophas, Lawson-Evi, Annette, Giddy, Janet, Amani-Bosse, Clarisse, Wood, Robin, and Egger, Matthias

Subjects
ANTI-HIV agents, ATTRIBUTION (Social psychology), CHILD development, COMPARATIVE studies, DATABASES, HIV infections, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, RESEARCH, RESEARCH funding, TIME, EVALUATION research, HIGHLY active antiretroviral therapy, EARLY medical intervention, CD4 lymphocyte count
Abstract

Background: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions.Methods: ART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation.Results: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes.Conclusions: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%. [ABSTRACT FROM AUTHOR]

Published
2016
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11. Independent predictors of tuberculosis mortality in a high HIV prevalence setting: a retrospective cohort study.

Author

Pepper, Dominique J., Schomaker, Michael, Wilkinson, Robert J., de Azevedo, Virginia, and Maartens, Gary

Subjects
*TUBERCULOSIS mortality, *TUBERCULOSIS risk factors, *AGE distribution, *CO-trimoxazole, *DEATH, *HEALTH care rationing, *HIV infections, *HIV-positive persons, *PATIENT aftercare, *EVALUATION of medical care, *MEDICAL needs assessment, *MULTIVARIATE analysis, *POPULATION, *POVERTY, *PUBLIC health surveillance, *RESEARCH, *TUBERCULOSIS, *DATA analysis, *HIGHLY active antiretroviral therapy, *ACQUISITION of data, *PROPORTIONAL hazards models, *RETROSPECTIVE studies, *CD4 lymphocyte count
Abstract

Background: Identifying those at increased risk of death during TB treatment is a priority in resource-constrained settings. We performed this study to determine predictors of mortality during TB treatment. Methods: We performed a retrospective analysis of a TB surveillance population in a high HIV prevalence area that was recorded in ETR.net (Electronic Tuberculosis Register). Adult TB cases initiated TB treatment from 2007 through 2009 in Khayelitsha, South Africa. Cox proportional hazards models were used to identify risk factors for death (after multiple imputations for missing data). Model selection was performed using Akaike's Information Criterion to obtain the most relevant predictors of death. Results: Of 16,209 adult TB cases, 851 (5.3 %) died during TB treatment. In all TB cases, advancing age, co-infection with HIV, a prior history of TB and the presence of both pulmonary and extra-pulmonary TB were independently associated with an increasing hazard of death. In HIV-infected TB cases, advancing age and female gender were independently associated with an increasing hazard of death. Increasing CD4 counts and antiretroviral treatment during TB treatment were protective against death. In HIV-uninfected TB cases, advancing age was independently associated with death, whereas smear-positive disease was protective. Conclusion: We identified several independent predictors of death during TB treatment in resource-constrained settings. Our findings inform resource-constrained settings about certain subgroups of TB patients that should be targeted to improve mortality during TB treatment. [ABSTRACT FROM AUTHOR]

Published
2015
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