CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

Holmes, Charles B.; Wood, Robin; Badri, Motasim; Zilber, Sophia; Wang, Bingxia; Maartens, Gary; Zheng, Hui; Lu, Zhigang; Freedberg, Kenneth A.; Losina, Elena

doi:10.1097/01.qai.0000225729.79610.b7

Cited by 156 publications

(166 citation statements)

References 28 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…Several studies have pointed out that the use of probiotics can significantly improve the wellbeing of individuals infected with HIV/AIDS (Anukam, 2007). For example, studies conducted in Africa have estimated the average annual increase in CD4 count of 90cells/mL with ARV treatment (Lawn et al, 2006) and an average decline of 20 to 50 cells/mL/year without ARV treatment (Holmes et al, 2006;Urassa et al, 2004). In the Tanzanian study, (Irvine et al, 2010), a similar rate of increase was observed of 99 cells/mL with ARV treatment (0.27 cells/mL/d), whereas no significant decrease was observed without ARV treatment.…”

Section: Can the Use Of Probiotics Make An Impact In Africa?supporting

confidence: 53%

Reducing Urogenital Infections Including HIV in Sub-Saharan Africa - Can Probiotics Be a Viable Paradigm?

Bassey¹,

Osazuwa²

2011

Microbes, Viruses and Parasites in AIDS Process

View full text Add to dashboard Cite

Section: Can the Use Of Probiotics Make An Impact In Africa?supporting

confidence: 53%

Reducing Urogenital Infections Including HIV in Sub-Saharan Africa - Can Probiotics Be a Viable Paradigm?

Bassey¹,

Osazuwa²

2011

Microbes, Viruses and Parasites in AIDS Process

View full text Add to dashboard Cite

“…We assumed that, compared to HIVnegative individuals, the incidence of TB would be 2, 4, 8, and 16 times higher among HIVpositive individuals with CD4+ counts >500, 350-500, 200-350, and <200, respectively [18][19][20][21]. Finally, we assumed HIV-specific mortality rates of 0.1/year for individuals with CD4+ counts higher than 200, and 0.35/year in individuals with CD4+ counts less than 200 [22].…”

Section: Hiv Prevalence Art Coverage and Hiv-tb Co-infectionmentioning

confidence: 99%

“…1, solid blue bars in panel C versus solid bar in panel D). Finally, we assumed effects of HIV on TB incidence in both mines and the labor-sending community as described above [18][19][20][21]. (Fig.…”

Section: Data and Model Calibrationmentioning

confidence: 99%

Impact of Targeted Tuberculosis Vaccination Among a Mining Population in South Africa: A Model-Based Study

Shrestha

Chihota

White

et al. 2017

American Journal of Epidemiology

View full text Add to dashboard Cite

Optimizing the use of new tools, such as vaccines, may play a crucial role in reaching global targets for tuberculosis (TB) control. Some of the most promising candidate vaccines target adults. However, high-coverage mass vaccinations may be logistically more challenging for adults than for children.Vaccine delivery strategies targeting high-risk groups or settings might yield proportionally greater impact than strategies that target the general population.We developed an individual-based TB transmission model representing a hypothetical population consisting of South African gold miners and the associated labor-sending communities. We simulated implementation of a post-infection adult vaccine with 60% efficacy and mean 10-year duration of effect, and compared the impact of a mine-targeted vaccination strategy, where miners were vaccinated while in the mines, against a communitytargeted strategy, where random individuals within the labor-sending communities were vaccinated. Mine-targeted vaccination averted an estimated 0.37 TB cases per vaccine dose, versus 0.25 for community-targeted vaccination, for a relative efficacy of 1.46 (95% range: 1.13-1.91). The added benefit of mine-targeted vaccination primarily reflected the disproportionate demographic burden of TB among adult males as a whole. As novel vaccines for TB are developed, venue-based vaccine delivery targeting high-risk demographic groups may improve both feasibility and transmission impact.

show abstract

“…28 Patients in care received cotrimoxazole prophylaxis at CD4 <200/µL, 29 generally reducing OD risk.…”

Section: Natural Historymentioning

confidence: 99%

The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials

2014

HIV Clinical Trials

View full text Add to dashboard Cite

Background: Several cluster-randomized HIV prevention trials aim to demonstrate the population-level preventive impact of antiretroviral therapy (ART). 2013 World Health Organization (WHO) guidelines raising the ART initiation threshold to CD4 <500/µL could attenuate these trials' effect size by increasing ART usage in control clusters. Methods: We used a computational model to simulate strategies from a hypothetical cluster-randomized HIV prevention trial. The primary model outcome was the relative reduction in 24-month HIV incidence between control (ART offered with CD4 below threshold) and intervention (ART offered to all) strategies. We assessed this incidence reduction using the revised (CD4 <500/µL) and prior (CD4 <350/µL) control ART initiation thresholds. Additionally, we evaluated changes to trial characteristics that could bolster the incidence reduction. Results: With a control ART initiation threshold of CD4 <350/µL, 24-month HIV incidence under control and intervention strategies was 2.46/100 person-years (PY) and 1.96/100 PY, a 21% reduction. Raising the threshold to CD4 <500/µL decreased the incidence reduction by more than one-third, to 12%. Using this higher threshold, moving to a 36-month horizon (vs 24-month), yearly control-strategy HIV screening (vs biannual), and intervention-strategy screening every 2 months (vs biannual), resulted in a 31% incidence reduction that was similar to effect size projections for ongoing trials. Alternate assumptions regarding cross-cluster contamination had the greatest infl uence on the incidence reduction. Conclusions: Implementing the 2013 WHO HIV treatment threshold could substantially diminish the incidence reduction in HIV population prevention trials. Alternative HIV testing frequencies and trial horizons can bolster this incidence reduction, but they could be logistically and ethically challenging. The feasibility of HIV population prevention trials should be reassessed as the implementation of treatment guidelines evolves.

show abstract

CD4 Decline and Incidence of Opportunistic Infections in Cape Town, South Africa

Abstract: : CD4 cell count declines were dependent on CD4 strata and can inform timing of clinic visits and treatment initiation in South Africa. Incidence rates of OIs suggest that targeted OI prophylaxis could prevent substantial HIV-related morbidity in South Africa.

Cited by 156 publications

References 28 publications

Reducing Urogenital Infections Including HIV in Sub-Saharan Africa - Can Probiotics Be a Viable Paradigm?

Reducing Urogenital Infections Including HIV in Sub-Saharan Africa - Can Probiotics Be a Viable Paradigm?

Impact of Targeted Tuberculosis Vaccination Among a Mining Population in South Africa: A Model-Based Study

The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials

Contact Info

Product

Resources

About