Browsing by Author "Anastos, Kathryn"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries.
    (2014-1) IeDEA and ART Cohort Collaborations; Avila, D.; Althoff, K. N.; Mugglin, C.; Wools-Kaloustian, K.; Koller, M.; Dabis, F.; Nash, D.; Gsponer, T.; Sungkanuparph, S.; McGowan, Catherine C.; May, M.; Cooper, D.; Chimbetete, C.; Wolff, Marcelo; Collier, A.; McManus, H.; Davies, M. A.; Costagliola, D.; Crabtree-Ramirez, Brenda; Chaiwarith, R.; Cescon, A.; Cornell, M.; Diero, L.; Phanuphak, P.; Sawadogo, A.; Ehmer, J.; Eholie, S. P.; Li, P. C.; Fox, M. P.; Gandhi, N. R.; González, E.; Lee, C. K.; Hoffmann, C. J.; Kambugu, A.; Keiser, O.; Ditangco, R.; Prozesky, H.; Lampe, F.; Kumarasamy, N.; Kitahata, M.; Lugina, E.; Lyamuya, R.; Vonthanak, S.; Fink, Valeria; d'Arminio Monforte, A.; Luz, P. M.; Chen, Y. M.; Minga, A.; Casabona, J.; Mwango, A.; Choi, J. Y.; Newell, M. L.; Bukusi, E. A.; Ngonyani, K.; Merati, T. P.; Otieno, J.; Bosco, M. B.; Phiri, S.; Ng, O. T.; Anastos, Kathryn; Rockstroh, J.; Santos, I.; Oka, S.; Somi, G.; Stephan, C.; Teira, R.; Wabwire, D.; Wandeler, G.; Boulle, A.; Reiss, Peter; Wood, R.; Chi, B. H.; Williams, C.; Sterne, J. A.; Egger, M.
    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/mL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/mL (76% increase), 88 to 135 cells/mL (53%), and 209 to 274 cells/mL (31%). In 2009, compared with LIC, median counts were 13 cells/mL [95% confidence interval (CI): 256 to +30] lower in LMIC, 22 cells/mL (262 to +18) lower in UMIC, and 112 cells/mL (+75 to +149) higher in HIC. They were 23 cells/mL (95% CI: +18 to +28 cells/mL) higher in women than men. Median counts were 88 cells/mL (95% CI: +35 to +141 cells/mL) 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/mL in LIC and MIC and below 300 cells/mL in HIC. Earlier start of cART will require substantial efforts and resources globally.
  • Thumbnail Image
    Item
    Tuberculosis in Antiretroviral Treatment Programs in Lower Income Countries: Availability and Use of Diagnostics and Screening
    (2013) Fenner, L.; Ballif, M.; Graber, C.; Nhandu, V.; Dusingize, J. C.; Carriquiry, Gabriela; Anastos, Kathryn; Garone, Daniela; Jong, Eefje; Gnokoro, Joachim Charles; Sued, Omar; Ajayi, Samuel; Diero, Lameck; Wools-Kaloustian, Kara; Kiertiburanakul, Sasisopin; Castelnuovo, Barbara; Lewden, Charlotte; Nicolas, Durier; Sterling, Matthias; Egger, Matthias; Cortes, Claudia
    Objectives: 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. Methods and findings: We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). Conclusions: Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.