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Geng EH, Neilands TB, Thièbaut R, Bosco Bwana M, Nash D, Moore RD, Wood R, Marcel Zannou D, Althoff KN, Lian Lim P, Nachega JB, Easterbrook PJ, Kambugu A, Little F, Nakigozi G, Nakanjako D, Kiggundu V, Chung Ki Li P, Bangsberg DR, Fox MP, Prozesky HW, Hunt PW, Davies MA, Reynolds SJ, Egger M, Yiannoutsos CT, Vittinghoff EV, Deeks SG, Martin JN. CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa. Int J Epidemiol 2015; 44:251-63. [PMID: 25859596 PMCID: PMC4339766 DOI: 10.1093/ije/dyu271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. METHODS We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. RESULTS After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa. CONCLUSIONS CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.
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Affiliation(s)
- Elvin H Geng
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
- *Corresponding author. Division of HIV/AIDS, San Francisco General Hospital, University of California at San Francisco, 995 Potrero Avenue, Building 80, Box 0874, San Francisco, CA 94110, USA. E-mail:
| | - Torsten B Neilands
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Rodolphe Thièbaut
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Mwebesa Bosco Bwana
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Denis Nash
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Richard D Moore
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Robin Wood
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Djimon Marcel Zannou
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Keri N Althoff
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Poh Lian Lim
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Jean B Nachega
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Philippa J Easterbrook
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Andrew Kambugu
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Francesca Little
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Gertrude Nakigozi
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Damalie Nakanjako
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Valerian Kiggundu
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Patrick Chung Ki Li
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - David R Bangsberg
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Matthew P Fox
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Hans W Prozesky
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Peter W Hunt
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Mary-Ann Davies
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Steven J Reynolds
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Matthias Egger
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Constantin T Yiannoutsos
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Eric V Vittinghoff
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Steven G Deeks
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
| | - Jeffrey N Martin
- University of California, San Francisco, CA, USA, INSERM U897, Bordeaux University, Bordeaux, France, Mbarara University of Science and Technology, Mbarara, Uganda, City University of New York, New York, NY, USA,Johns Hopkins University, Baltimore, MD, USA, University of Cape Town, Cape Town, South Africa, Centre National Hospitalier Universitaire, Cotonou, Benin, Institute of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburg, PA, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine & Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Infectious Diseases Institute, Kampala, Uganda, Rakai Health Sciences Program, Kalisizo, Uganda, Queen Elizabeth Hospital, Hong Kong, China, Center for Global Health, Massachusetts General Hospital, Harvard University, Boston, MA, USA, Center for Global Health and Development, Boston University, Boston, MA, USA, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa, National Institutes of Allergy and Infectious Diseases, Washington DC, USA, University of Bern, Bern, Switzerland and Indiana University, Indianapolis, IN, USA
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