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

Abstract

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.

Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial

“…26,27 In this current analysis, the reported incidence of non-AIDS events was low, with no difference recorded between study groups. Serious adverse events possibly attributable to anti-retroviral treatment were also infrequent.…”

Kidney Disease in HIV-Infected Persons

“…Renal failure accounted for 4 of 18 (22%) events in Tennessee versus 6 of 25 (25%) in Botswanna, with similar incidence rates (2.4 vs. 3.0 per 1,000 person-years, in Tennessee and Botswanna, respectively) [38]. Together, these studies describe a complex, and as yet an incomplete picture among sub-Saharan Africans living with HIV.…”

Multiple Micronutrient Supplementation Effect on Vital Metabolic parameters of Stable HIV Patients on Long term Highly Active Antiretroviral Therapy; A Randomized Crossover Trial

“…Nutritionappears to play a role in the development of non AIDS defining illnesses in HIV patients on long term HAART as a study by Wester et al (Wester et al, 2011) reported an increased incidence of non AIDS defining illnesses in an African Cohort especially among the overweight adults. With HIV and nutrition being strongly related, the nutritional implications in the prognosis and management of HIV infection especially in developing countries is highlighted by the associated prevalence of nutrient deficiencies established early in the course of HIV infection coupled with the fact that micronutrient deficiencies are more likely to occur among residents of developing countries like Nigeria; that is ranked the 3 rd highest with respect to absolute numbers of stunting with annual losses of US$1.5 billion in Gross Domestic Product due to vitamins and mineral deficiencies (Montaner et al, 1998; United Nations Children's Fund (UNICEF),2009; World Bank; Jiang et al, 2012).…”

“…A Swiss Cohort study observed that while the incidences of AIDS defining events are reducing, the non AIDS defining events are increasing with aging and as a consequence, the non AIDS related diseases are now becoming major causes of health concern in HIV patients on long term HAART with associated morbidity and mortality [Hasse et al, 2011;The Antiretroviral Therapy Cohort Collaboration (ART-CC writing committee);2010]. This particularly appears to be constituting a significant problem in sub Saharan Africa and therefore requires that monitoring, prevention and treatment should be a critical component of care in resource limited regions (Wester et al, 2011).…”

“…The clinical consequences of effective and widespread use of HAART has been longer survival and improved quality of life of HIV infected patients with the emergence of non AIDS defining illnesses such as malignancies, cardiovascular, renal, hepatic and other related disorders with its associated abnormal levels of metabolic parameters (Montaner et al, 1998;Walensky et al;Wester et al, 2011).…”