When to start antiretroviral treatment? A history and analysis of a scientific controversy

Geffen, Nathan; Low, Marcus

doi:10.4102/sajhivmed.v18i1.734

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…This early initiation of ARV drugs has a hallmark that the CD4 count remains high which could account for a difference in the prevalence of NCI across the study period. 52–56 …”

Section: Discussionmentioning

confidence: 99%

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Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies

Zenebe¹,

Akele²,

W/Selassie³

et al. 2023

NDT

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Background Neurocognitive impairment (NCI) is one of the most common neurological complications in HIV-positive individuals, particularly in resource-limited countries. Neurocognitive impairments can occur at any stage of HIV infection, although the risk increases as the infection progresses. However, in Africa, there are few studies with highly variable and inconsistent results. Therefore, this study aimed to determine the prevalence and factors associated with NCI among HIV-positive people in Africa. Methods For this systematic review and meta-analysis, we used PubMed/Medline, Scopus, Web of Science, the Cochrane Library, Embase, and PsycINFO to comprehensively search a number of papers. Studies reporting the prevalence of NCI and its factors were included in the estimation of the pooled prevalence. A consistent data extraction format was created in Microsoft Excel to extract the data, which was then imported into STATA 11 statistical software for analysis. The heterogeneity was evaluated using the I2 test, and a random effect meta-analysis model was employed to calculate the pooled prevalence of NCI because the included studies showed significant heterogeneity. Results In all, Africa had a pooled prevalence of NCI of 45.15% (95% CI: 36.86, 53.43). According to the subgroup analysis of this study, West Africa had the lowest frequency, at 42.40% (95% CI: 22.03, 62.77), whereas Central and South Africa had the highest prevalence, at 49.33% (95% CI: 10.72–87.95). Conclusion In Africa, the cumulative prevalence of NCI was high. Being a woman, not having a formal education, those with only an elementary education, being older, having late-stage HIV, and abusing drugs were all often associated with NCI. The average burden of NCI in Africa is high and that would be a significant figure for interventional actions in the area.

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“…This early initiation of ARV drugs has a hallmark that the CD4 count remains high which could account for a difference in the prevalence of NCI across the study period. 52–56 …”

Section: Discussionmentioning

confidence: 99%

“…This early initiation of ARV drugs has a hallmark that the CD4 count remains high which could account for a difference in the prevalence of NCI across the study period. [52][53][54][55][56] In this study, females were three times more likely to develop NCI than males. This could be due to the high vulnerability of females to contracting HIV.…”

mentioning

confidence: 98%

Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies

Zenebe¹,

Akele²,

W/Selassie³

et al. 2023

NDT

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“…29,30 Before the introduction of the universal test-and-treat programme, there were concerns that commencing ART among people with high CD4+ T-cell counts would overburden the health system and that those feeling healthy would not adhere to treatment. 31 However, of the PLWH in KwaZulu-Natal with CD4+ T-cell counts of > 500 cells/µL, 78% accepted ART, 32 86% were adherent 33 and 96% achieved viral suppression. 34 Furthermore, retention in care and viral suppression were similar among people who initiated ART with CD4+ T-cell counts of > 500 cells/µL compared to those with lower CD4+ T-cell counts.…”

Section: Challenges For Achieving 95-95-95 In Esa the First 95mentioning

confidence: 99%

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

Parker

Judge

Macete

et al. 2021

Southern African Journal of HIV Medicine

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Background: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared.Objectives: This report summarises relevant evidence and regional experts’ recommendations regarding challenges specific to ESA.Method: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts.Results: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA.Conclusion: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.

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Social histories of public health misinformation and infodemics: case studies of four pandemics

Jin,

Kolis,

Parker

et al. 2024

The Lancet Infectious Diseases

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When to start antiretroviral treatment? A history and analysis of a scientific controversy

Cited by 4 publications

References 33 publications

Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies

Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

Social histories of public health misinformation and infodemics: case studies of four pandemics

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