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Chen W, Petoumenos K, Somia A, Edmiston N, Chaiwarith R, Woolley I, Ross J, Pujari S, Boettiger DC. Changes in atherosclerotic cardiovascular disease risk over time among people living with HIV. J Antimicrob Chemother 2024; 79:897-902. [PMID: 38416697 PMCID: PMC10984948 DOI: 10.1093/jac/dkae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV). METHODS We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligible for inclusion if they were aged ≥18 years, had started ART, had no previous history of ASCVD and had complete ASCVD risk factor data available within the first 5 years of ART initiation. RESULTS A total of 3368 adults contributed data, 3221 were from TAHOD and 147 were from AHOD. The median age at ART initiation was 36 [IQR 31-43] years for TAHOD participants, and 42 [IQR 35-50] years for AHOD participants. Most TAHOD (70.4%) and AHOD (91.8%) participants were male. Overall, ASCVD risk increased from 0.84% (95% CI 0.81%-0.87%) at ART initiation to 1.34% (95% CI 1.29%-1.39%) after 5 years on ART. After adjusting for traditional and HIV-associated ASCVD risk factors, ASCVD risk increased at a similar rate among sub-populations defined by HIV exposure (heterosexuals, men who have sex with men, people who inject drugs), race/ethnicity (Caucasian and Asian) and nadir CD4 at ART initiation (<200 and ≥200 cells/mm3). CONCLUSIONS These findings emphasize the growing burden of ASCVD risk among PLHIV and the need to develop interventions that are effective across a broad range of HIV sub-populations.
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Affiliation(s)
- Weisi Chen
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Agus Somia
- Department of Tropical and Infectious Diseases, Udayana University, Denpasar, Indonesia
| | - Natalie Edmiston
- School of Medicine, Rural Research, Western Sydney University, Sydney, Australia
| | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, Australia
| | - Jeremy Ross
- TREAT Asia, amfAR—The Foundation for AIDS Research, Bangkok, Thailand
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Boettiger DC, Lin TK, Almansour M, Hamza MM, Alsukait R, Herbst CH, Altheyab N, Afghani A, Kattan F. Projected impact of population aging on non-communicable disease burden and costs in the Kingdom of Saudi Arabia, 2020-2030. BMC Health Serv Res 2023; 23:1381. [PMID: 38066590 PMCID: PMC10709902 DOI: 10.1186/s12913-023-10309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The number of people aged greater than 65 years per 100 people aged 20-64 years is expected to almost double in The Kingdom of Saudi Arabia (KSA) between 2020 and 2030. We therefore aimed to quantify the growing non-communicable disease (NCD) burden in KSA between 2020 and 2030, and the impact this will have on the national health budget. METHODS Ten priority NCDs were selected: ischemic heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, dementia, depression, osteoarthritis, colorectal cancer, and breast cancer. Age- and sex-specific prevalence was projected for each priority NCD between 2020 and 2030. Treatment coverage rates were applied to the projected prevalence estimates to calculate the number of patients incurring treatment costs for each condition. For each priority NCD, the average cost-of-illness was estimated based on published literature. The impact of changes to our base-case model in terms of assumed disease prevalence, treatment coverage, and costs of care, coming into effect from 2023 onwards, were explored. RESULTS The prevalence estimates for colorectal cancer and stroke were estimated to almost double between 2020 and 2030 (97% and 88% increase, respectively). The only priority NCD prevalence projected to increase by less than 60% between 2020 and 2030 was for depression (22% increase). It is estimated that the total cost of managing priority NCDs in KSA will increase from USD 19.8 billion in 2020 to USD 32.4 billion in 2030 (an increase of USD 12.6 billion or 63%). The largest USD value increases were projected for osteoarthritis (USD 4.3 billion), diabetes (USD 2.4 billion), and dementia (USD 1.9 billion). In scenario analyses, our 2030 projection for the total cost of managing priority NCDs varied between USD 29.2 billion - USD 35.7 billion. CONCLUSIONS Managing the growing NCD burden in KSA's aging population will require substantial healthcare spending increases over the coming years.
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Grants
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
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Affiliation(s)
- David C Boettiger
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA.
| | - Tracy Kuo Lin
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA
| | | | - Mariam M Hamza
- Nutrition and Population Global Practice, World Bank, Washington, D.C, USA
| | - Reem Alsukait
- Community Health Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Nada Altheyab
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Ayman Afghani
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Faisal Kattan
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
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Babagoli MA, Chen YH, Chakma N, Islam MS, Naheed A, Boettiger DC. Association of socio-demographic characteristics with hypertension awareness, treatment, and control in Bangladesh. J Hum Hypertens 2023; 37:993-999. [PMID: 36882527 DOI: 10.1038/s41371-023-00815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/30/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
Hypertension has been rapidly growing in Bangladesh. However, there has been limited analysis of differences in the hypertension cascade across socio-demographic groups. This study was a secondary analysis of the 2017-18 Bangladesh Demographic and Health Survey. Four dichotomous outcome variables - hypertension prevalence, awareness among those with hypertension, treatment among those aware, and control among those treated - were analyzed. The variation of each outcome was assessed across socio-demographic factors. The association between socio-demographic characteristics and outcomes was analyzed using logistic regression. Less than half of the hypertensive individuals were aware of their hypertension (42.5%), and awareness was higher among those who were older, female, of higher household wealth, and living in urban areas. Among those aware, most were receiving treatment (87.4%), and this proportion was higher in older individuals (89.2% among 65 + , 70.4% among 18-24; p < 0.001). One-third of those treated (33.8%) had their blood pressure controlled, and this was higher among younger and more educated individuals. In multivariable models stratified by rural/urban community, most of the aforementioned trends remained with additional differences between communities. Notably, the association of higher education level with treatment odds differed in rural and urban communities (OR 0.34 [95%CI 0.16, 0.75] in rural; OR 2.83 [95%CI 1.04, 7.73] in urban). Efforts to improve hypertension awareness among individuals who are younger, male, of lower household wealth, and in rural areas are required to address disparities in care. Socio-demographic variations in hypertension awareness, treatment, and control must be considered to design targeted interventions for each step of the cascade.
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Affiliation(s)
- Masih A Babagoli
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Yea-Hung Chen
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nantu Chakma
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Saimul Islam
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Aliya Naheed
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - David C Boettiger
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Cheng Q, Poynten IM, Jin F, Grulich A, Ong JJ, Hillman RJ, Hruby G, Howard K, Newall AT, Boettiger DC. Cost-effectiveness of treating serendipitously diagnosed anal pre-cancerous lesions among gay, bisexual and other men who have sex with men living with HIV. Lancet Reg Health West Pac 2023; 37:100756. [PMID: 37693870 PMCID: PMC10485666 DOI: 10.1016/j.lanwpc.2023.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - I. Mary Poynten
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Richard J. Hillman
- Kirby Institute, University of New South Wales, Sydney, Australia
- HIV and Immunology, St Vincent's Hospital, Sydney, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
- Menzies Centre for Health Policy & Economics, University of Sydney, Sydney, Australia
- Genesis Cancer Care, Sydney, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy & Economics, University of Sydney, Sydney, Australia
| | - Anthony T. Newall
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David C. Boettiger
- Kirby Institute, University of New South Wales, Sydney, Australia
- Institute for Health and Aging, University of California, San Francisco, USA
- Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Cheng Q, Poynten IM, Jin F, Grulich A, Ong JJ, Hillman RJ, Hruby G, Howard K, Newall A, Boettiger DC. Cost-effectiveness of screening and treating anal pre-cancerous lesions among gay, bisexual and other men who have sex with men living with HIV. Lancet Reg Health West Pac 2023; 32:100676. [PMID: 36785857 PMCID: PMC9918792 DOI: 10.1016/j.lanwpc.2022.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
Background Gay, bisexual and other men who have sex with men (GBM) living with HIV have a substantially elevated risk of anal cancer (85 cases per 100,000 person-years vs 1-2 cases per 100,000 person-years in the general population). The precursor to anal cancer is high-grade squamous intraepithelial lesion (HSIL). Findings regarding the cost-effectiveness of HSIL screening and treatment in GBM are conflicting. Using recent data on HSIL natural history and treatment effectiveness, we aimed to improve upon earlier models. Methods We developed a Markov cohort model populated using observational study data and published literature. Our study population was GBM living with HIV aged ≥35 years. We used a lifetime horizon and framed our model on the Australian healthcare perspective. The intervention was anal HSIL screening and treatment. Our primary outcome was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life-year (QALY) gained. Findings Anal cancer incidence was estimated to decline by 44-70% following implementation of annual HSIL screening and treatment. However, for the most cost-effective screening method assessed, the ICER relative to current practice, Australian Dollar (AUD) 135,800 per QALY gained, remained higher than Australia's commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained. In probabilistic sensitivity analyses, HSIL screening and treatment had a 20% probability of being cost-effective. When the sensitivity and specificity of HSIL screening were enhanced beyond the limits of current technology, without an increase in the cost of screening, ICERs improved but were still not cost-effective. Cost-effectiveness was achieved with a screening test that had 95% sensitivity, 95% specificity, and cost ≤ AUD 24 per test. Interpretation Establishing highly sensitive and highly specific HSIL screening methods that cost less than currently available techniques remains a research priority. Funding No specific funding was received for this analysis.
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Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - I. Mary Poynten
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia,London School of Hygiene and Tropical Medicine, London, UK,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Richard J. Hillman
- Kirby Institute, University of New South Wales, Sydney, Australia,Dysplasia and Anal Cancer Services, St Vincent's Hospital, Sydney, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia,University of Sydney, Sydney, Australia,Genesis Cancer Care, Sydney, Australia
| | | | - Anthony Newall
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David C. Boettiger
- Kirby Institute, University of New South Wales, Sydney, Australia,Institute for Health and Aging, University of California, San Francisco, USA,Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Corresponding author. Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW 2052. Australia.
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Boettiger DC, Huque MH, Bloch M, Woolley I, Templeton DJ, Law MG, Fraser N, Hoy J, Petoumenos K. Physical function limitation among gay and bisexual men aged ≥55years with and without HIV: findings from the Australian Positive and Peers Longevity Evaluation Study (APPLES). Sex Health 2022; 19:533-545. [PMID: 36089288 DOI: 10.1071/sh22085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND As people living with HIV now have a life expectancy approaching that of the general population, clinical care focuses increasingly on the management and prevention of comorbidities and conditions associated with aging. We aimed to assess the prevalence of physical function (PF) limitation among gay and bisexual men (GBM) and determine whether HIV is associated with severe PF limitation in this population. METHODS We analysed cross-sectional data from GBM aged ≥55years in the Australian Positive and Peers Longevity Evaluation Study who completed a self-administered survey on health and lifestyle factors. PF was measured using the Medical Outcomes Study-Physical Functioning scale. Factors associated with severe PF limitation were assessed using logistic regression. RESULTS The survey was completed by 381 men: 186 without HIV and 195 with HIV. Median age was 64.3years for GBM without HIV and 62.1years for GBM with HIV. Compared with men without HIV, those with HIV had higher proportions of severe (13.3% vs 8.1%) and moderate-to-severe (26.7% vs 24.2%) PF limitation. Severe PF limitation commonly involved difficulty with vigorous activity (95% with severe PF limitation described being limited a lot), climbing several flights of stairs (68.4% limited a lot), bending, kneeling or stooping (60.5% limited a lot), and walking 1km (55.0% limited a lot). In a model adjusted for age, body mass index, typical duration of physical activity, psychological distress, and number of comorbidities, we found a significant association between HIV and severe PF limitation (adjusted odds ratio 3.3 vs not having HIV, 95% confidence interval 1.3-8.7). CONCLUSIONS The biological mechanisms underlying this association require further investigation, particularly given the growing age of the HIV population and inevitable increase in the burden of PF limitation.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Institute for Health and Aging, University of California, San Francisco, CA, USA; and Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Mark Bloch
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Holdsworth House Medical Practice, Sydney, NSW, Australia
| | - Ian Woolley
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Vic., Australia; and Monash Infectious Diseases, Monash Health and Centre for Inflammatory Diseases, Monash University, Melbourne, Vic., Australia
| | - David J Templeton
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia; and Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Matthew G Law
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Vic., Australia
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Han WM, Kerr SJ, Avihingsanon A, Boettiger DC. Weight change with integrase strand transfer inhibitors among virally suppressed Thai people living with HIV. J Antimicrob Chemother 2022; 77:3242-3247. [PMID: 36101517 DOI: 10.1093/jac/dkac306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We compared weight changes in virally suppressed people living with HIV (PLWH) switching to integrase strand transfer inhibitors (INSTIs) with those remaining on an INSTI or non-INSTI regimen. METHODS PLWH aged ≥18 years with weight measurements available at baseline between 2001 and 2020 were included. Viral suppression was defined as having had a viral load <400 copies/mL for 6 months. Baseline was defined as the time of switching from a non-INSTI to an INSTI regimen whilst virally suppressed (switch group) or the time that viral suppression was achieved (remain groups). Generalized estimating equations adjusted for age, sex and baseline weight were used to model weight changes 6, 12, 18 and 24 months after baseline. RESULTS A total of 1673 PLWH contributed 1952 episodes of viral suppression-143 (7.3%) episodes were among PLWH who had switched from a non-INSTI to an INSTI, 102 (5.2%) episodes were among PLWH who remained on an INSTI and 1707 (87.4%) episodes were among PLWH who remained on a non-INSTI. PLWH in the switch group had significantly greater weight gain than those in the remain groups at 6, 12 and 18 months after achieving viral suppression. By 24 months, weight change on all regimens started to converge. Tenofovir alafenamide use was not significantly associated with weight gain in adjusted models. CONCLUSIONS Our findings suggest that the mechanisms of weight gain due to INSTI use go beyond their superior efficacy over other antiretrovirals in controlling HIV or the effect of the 'return-to-health' phenomenon. Further research is needed to understand the mechanisms of such weight gain.
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Affiliation(s)
- Win Min Han
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand.,The Kirby Institute, UNSW Sydney, Sydney 2052, Australia.,Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand.,The Kirby Institute, UNSW Sydney, Sydney 2052, Australia.,Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand.,Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - David C Boettiger
- The Kirby Institute, UNSW Sydney, Sydney 2052, Australia.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Institute for Health and Aging, University of California, San Francisco, CA 94102, USA
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Boettiger DC, Chattranukulchai P. Considering Whether Countries Participating in Clinical Trials can Afford the Intervention. Health Policy Plan 2022; 37:1064-1065. [PMID: 35674252 DOI: 10.1093/heapol/czac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/11/2022] [Accepted: 06/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- D C Boettiger
- Kirby Institute, UNSW Sydney, Australia.,Institute for Health and Aging, University of California, San Francisco, USA.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - P Chattranukulchai
- Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Boettiger DC, An VT, Kumarasamy N, Azwa I, Sudjaritruk T, Truong KH, Avihingsanon A, Ross J, Kariminia A. Recent Trends in Adult and Pediatric Antiretroviral Therapy Monitoring and Failure. J Acquir Immune Defic Syndr 2022; 90:193-200. [PMID: 35125475 PMCID: PMC9203901 DOI: 10.1097/qai.0000000000002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess recent trends in the monitoring of antiretroviral therapy (ART) and detection of ART failure in adult and pediatric HIV clinics. METHODS We used data collected from 21 adult and 17 pediatric sites (across 13 and 6 countries/territories, respectively) in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific cohort. ART failure was defined as viral, immune, or clinical consistent with WHO guidelines. RESULTS A total of 8567 adults and 6149 children contributed data. Frequency of CD4 count monitoring declined between 2010 and 2019 among adult sites (from 1.93 to 1.06 tests/person per year, a 45.1% decline) and pediatric sites (from 2.16 to 0.86 testsperson per year, a 60.2% decline), whereas rates of viral load monitoring remained relatively stable. The proportion of adult and pediatric treatment failure detected as immune failure declined (from 73.4% to 50.0% and from 45.8% to 23.1%, respectively), whereas the proportion of failure detected as viral failure increased (from 7.8% to 25.0% and from 45.8% to 76.9%, respectively). The proportion of ART failure detected as clinical failure remained stable among adult and pediatric sites. The largest shifts in ART monitoring and failure type occurred in lower middle-income countries. CONCLUSIONS Although viral failure in our Asian cohort now comprises a larger portion of ART failure than in prior years, the diagnostic characteristics of immune and clinical failure, and recommendations on their management, remain important inclusions for regional ART guidelines.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, Australia
- Institute for Health and Aging, University of California, San Francisco, USA
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vu Thien An
- Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Nagalingeswaran Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, India
| | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Anchalee Avihingsanon
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeremy Ross
- TREAT Asia/amfAR–Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, Australia
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Boettiger DC, An VT, Lumbiganon P, Wittawatmongkol O, Truong KH, Do VC, Van Nguyen L, Ly PS, Kinikar A, Ounchanum P, Puthanakit T, Kurniati N, Kumarasamy N, Wati DK, Chokephaibulkit K, Jamal Mohamed TA, Sudjaritruk T, Yusoff NKN, Fong MS, Nallusamy RA, Kariminia A. Severe Recurrent Bacterial Pneumonia Among Children Living With HIV. Pediatr Infect Dis J 2022; 41:e208-e215. [PMID: 35185140 PMCID: PMC10140183 DOI: 10.1097/inf.0000000000003494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bacterial pneumonia imparts a major morbidity and mortality burden on children living with HIV, yet effective prevention and treatment options are underutilized. We explored clinical factors associated with severe recurrent bacterial pneumonia among children living with HIV. METHODS Children enrolled in the TREAT Asia Pediatric HIV Observational Database were included if they started antiretroviral therapy (ART) on or after January 1st, 2008. Factors associated with severe recurrent bacterial pneumonia were assessed using competing-risk regression. RESULTS A total of 3,944 children were included in the analysis; 136 cases of severe recurrent bacterial pneumonia were reported at a rate of 6.5 [95% confidence interval (CI): 5.5-7.7] events per 1,000 patient-years. Clinical factors associated with severe recurrent bacterial pneumonia were younger age [adjusted subdistribution hazard ratio (aHR): 4.4 for <5 years versus ≥10 years, 95% CI: 2.2-8.4, P < 0.001], lower weight-for-age z-score (aHR: 1.5 for <-3.0 versus >-2.0, 95% CI: 1.1-2.3, P = 0.024), pre-ART diagnosis of severe recurrent bacterial pneumonia (aHR: 4.0 versus no pre-ART diagnosis, 95% CI: 2.7-5.8, P < 0.001), past diagnosis of symptomatic lymphoid interstitial pneumonitis or chronic HIV-associated lung disease, including bronchiectasis (aHR: 4.8 versus no past diagnosis, 95% CI: 2.8-8.4, P < 0.001), low CD4% (aHR: 3.5 for <10% versus ≥25%, 95% CI: 1.9-6.4, P < 0.001) and detectable HIV viral load (aHR: 2.6 versus undetectable, 95% CI: 1.2-5.9, P = 0.018). CONCLUSIONS Children <10-years-old and those with low weight-for-age, a history of respiratory illness, low CD4% or poorly controlled HIV are likely to gain the greatest benefit from targeted prevention and treatment programs to reduce the burden of bacterial pneumonia in children living with HIV.
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Affiliation(s)
- David C. Boettiger
- The Kirby Institute, UNSW Sydney, Australia
- Institute for Health and Aging, University of California, San Francisco, USA
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vu Thien An
- Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Pagakrong Lumbiganon
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Orasri Wittawatmongkol
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | - Aarti Kinikar
- BJ Medical College and Sassoon General Hospitals, Maharashtra, India
| | | | - Thanyawee Puthanakit
- Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nia Kurniati
- Cipto Mangunkusumo – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thahira A. Jamal Mohamed
- Department of Pediatrics, Women and Children Hospital Kuala Lumpur (WCHKL), Kuala Lumpur, Malaysia
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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11
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Adawiyah RA, Saweri OPM, Boettiger DC, Applegate TL, Probandari A, Guy R, Guinness L, Wiseman V. The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:939-954. [PMID: 33693731 PMCID: PMC8227996 DOI: 10.1093/heapol/czab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/18/2022] Open
Abstract
Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The 'true' cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.
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Affiliation(s)
- Rabiah Al Adawiyah
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Olga P M Saweri
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea
| | - David C Boettiger
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.,Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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12
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Boettiger DC, White JS. Effects of a minimum floor Price law on cigarette use in Oakland, California: A static microsimulation model. Prev Med 2021; 145:106444. [PMID: 33529637 DOI: 10.1016/j.ypmed.2021.106444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Tobacco minimum floor price laws (MFPLs) are a non-tax price policy that set a price below which tobacco products cannot be sold, thereby raising prices. Despite their growing interest among policy makers, little is known about the effects of local MFPLs on smoking prevalence or smoking intensity. We aimed to project the impact of a local tobacco MFPL on cigarette smoking prevalence and cigarette smoking intensity in Oakland, California, including detailed analysis of several important subpopulations. We used data collected between April 2017 and December 2019 from the California Behavioral Risk Factor Surveillance System and the National Youth Tobacco Survey to construct a static microsimulation model representative of Oakland. We projected the impact of MFPLs ranging from $8.00 to $13.00 per pack. All analyses were conducted between 2019 and 2020. With the introduction of an MFPL and assuming 15% policy evasion, mean price paid per pack was projected to increase by $1.05 to $4.69, cigarette smoking prevalence was projected to drop by 0.3% to 0.8%, and smoking intensity was projected to drop by 0.7% to 2.0% among continuing smokers. Total number of cigarettes smoked per month was projected to drop by 246,000 to 734,000 cigarettes, a 3.0% to 9.0% reduction from the current level (8.2 million cigarettes). The greatest reductions in cigarette smoking prevalence were among those aged 12 to 24-years-old, of non-Hispanic black or other race/ethnicity, and living below the federal poverty level. An MFPL in Oakland may substantially reduce cigarette use and target several important subpopulations.
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Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
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13
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Abstract
OBJECTIVE Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy (ART)/statin interactions. We estimated rates of statin discontinuation and reinitiation, and the percentage of days covered by statin use among PLHIV on ART, and investigated factors associated with these outcomes. DESIGN Observational cohort study. METHODS Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001 and 2020 were analyzed using Kaplan-Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days. RESULTS Data on 318 PLHIV were included. After 1, 3, and 5 years, 22.3, 50.8, and 61.1% had discontinued statin use, respectively. Among those who discontinued (n = 178), 52.0% reinitiated statin use within 5 years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin reinitiation were older age, diabetes, and high levels of LDL cholesterol. The adjusted mean percentage of days covered by a statin was 86.7, 61.1, and 58.1% in the 6 months prior to 1, 3, and 5 years of follow-up, respectively. CONCLUSION Maintenance of statin therapy is poor among PLHIV on ART but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
| | - Stephen Kerr
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
| | | | | | - Anchalee Avihingsanon
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Boettiger DC, Newall AT, Phillips A, Bendavid E, Law MG, Ryom L, Reiss P, Mocroft A, Bonnet F, Weber R, El‐Sadr W, d’Arminio Monforte A, de Wit S, Pradier C, Hatleberg CI, Lundgren J, Sabin C, Kahn JG, Kazi DS. Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States. J Int AIDS Soc 2021; 24:e25690. [PMID: 33749164 PMCID: PMC7982504 DOI: 10.1002/jia2.25690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States. METHODS We developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years. RESULTS Persons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal. CONCLUSIONS Pravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.
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Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
- Kirby InstituteUNSW SydneySydneyNSWAustralia
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonLondonUK
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - Lene Ryom
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Peter Reiss
- Amsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- HIV Monitoring FoundationAmsterdamThe Netherlands
| | - Amanda Mocroft
- Institute for Global HealthUniversity College LondonLondonUK
| | | | - Rainer Weber
- University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Wafaa El‐Sadr
- ICAP‐Columbia University and Harlem HospitalNew YorkNYUSA
| | | | - Stephane de Wit
- Saint Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | | | - Jens Lundgren
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Caroline Sabin
- Institute for Global HealthUniversity College LondonLondonUK
| | - James G Kahn
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Dhruv S Kazi
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolHarvard UniversityBostonMAUSA
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15
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Boettiger DC, Treleaven E, Kayentao K, Guindo M, Coumaré M, Johnson AD, Whidden C, Koné N, Cissé AB, Padian N, Liu J. Household factors and under-five mortality in Bankass, Mali: results from a cross-sectional survey. BMC Public Health 2021; 21:244. [PMID: 33514345 PMCID: PMC7845123 DOI: 10.1186/s12889-021-10242-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rural parts of Mali carry a disproportionate burden of the country's high under-five mortality rate. A range of household factors are associated with poor under-five health in resource-limited settings. However, it is unknown which most influence the under-five mortality rate in rural Mali. We aimed to describe household factors associated with under-five mortality in Bankass, a remote region in central Mali. METHODS We analysed baseline household survey data from a trial being conducted in Bankass. The survey was administered to households between December 2016 and January 2017. Under-five deaths in the five years prior to baseline were documented along with detailed information on household factors and women's birth histories. Factors associated with under-five mortality were analysed using Cox regression. RESULTS Our study population comprised of 17,408 under-five children from 8322 households. In the five years prior to baseline, the under-five mortality rate was 152.6 per 1000 live births (158.8 and 146.0 per 1000 live births for males and females, respectively). Living a greater distance from a primary health center was associated with a higher probability of under-five mortality for both males (adjusted hazard ratio [aHR] 1.53 for ≥10 km versus < 2 km, 95% confidence interval [CI] 1.25-1.88) and females (aHR 1.59 for ≥10 km versus < 2 km, 95% CI 1.27-1.99). Under-five male mortality was additionally associated with lower household wealth quintile (aHR 1.47 for poorest versus wealthiest, 95%CI 1.21-1.78), lower reading ability among women of reproductive age in the household (aHR 1.73 for cannot read versus can read, 95%CI 1.04-2.86), and living in a household with access to electricity (aHR 1.16 for access versus no access, 95%CI 1.00-1.34). CONCLUSIONS U5 mortality is very high in Bankass and is associated with living a greater distance from healthcare and several other household factors that may be amenable to intervention or facilitate program targeting.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, 2252, Australia.
| | - Emily Treleaven
- Population Studies Center, University of Michigan, Ann Arbor, USA
| | - Kassoum Kayentao
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Mama Coumaré
- Ministère de la Santé et des Affaires Sociales, Bamako, Mali
| | - Ari D Johnson
- Department of Medicine, University of California, San Francisco, USA
| | | | | | | | - Nancy Padian
- School of Public Health, University of California, Berkeley, USA
| | - Jenny Liu
- Institute for Health and Aging, University of California, San Francisco, USA
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16
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Boettiger DC, Salazar-Vizcaya L, Dore GJ, Gray RT, Law MG, Callander D, Lea T, Rauch A, Matthews GV. Can Australia Reach the World Health Organization Hepatitis C Elimination Goal by 2025 Among Human Immunodeficiency Virus-positive Gay and Bisexual Men? Clin Infect Dis 2021; 70:106-113. [PMID: 30816916 DOI: 10.1093/cid/ciz164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive gay and bisexual men (GBM) in Australia are well engaged in care. The World Health Organization's (WHO) hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030 may be reachable ahead of time in this population. METHODS We predicted the effect of treatment and behavioral changes on HCV incidence among HIV-positive GBM up to 2025 using a HCV transmission model parameterized with Australian data. We assessed the impact of changes in behavior that facilitate HCV transmission in the context of different rates of direct-acting antiviral (DAA) use. RESULTS HCV incidence in our model increased from 0.7 per 100 person-years in 2000 to 2.5 per 100 person-years in 2016 and had the same trajectory as previously reported clinical data. If the proportion of eligible (HCV RNA positive) patients using DAAs stays at 65% per year between 2016 and 2025, with high-risk sexual behavior and injecting drug use remaining at current levels, HCV incidence would drop to 0.4 per 100 person-years (85% decline from 2016). In the same treatment scenario but with substantial increases in risk behavior, HCV incidence would drop to 0.6 per 100 person-years (76% decline). If the proportion of eligible patients using DAAs dropped from 65% per year in 2016 to 20% per year in 2025 and risk behavior did not change, HCV incidence would drop to 0.7 per 100 person-years (70% reduction). CONCLUSIONS Reaching the WHO HCV elimination target by 2025 among HIV-positive GBM in Australia is achievable.
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Affiliation(s)
| | - Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Inselpital, Switzerland
| | - Gregory J Dore
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Richard T Gray
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Matthew G Law
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Denton Callander
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Toby Lea
- Centre for Social Research in Health, University of New South Wales Sydney, Australia.,German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Cologne
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Inselpital, Switzerland
| | - Gail V Matthews
- Kirby Institute, University of New South Wales Sydney, Australia
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17
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Boettiger DC, Kerr S, Chattranukulchai P, Siwamogsatham S, Avihingsanon A. Reclassification of Statin Indication Among People Living With HIV Using Coronary Artery Calcium Scoring. J Acquir Immune Defic Syndr 2020; 85:e26-e29. [PMID: 32925388 DOI: 10.1097/qai.0000000000002430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, Australia
- Institute for Health and Aging, University of California, San Francisco, CA
| | - Stephen Kerr
- HIV-Netherlands Australia Thailand/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Pairoj Chattranukulchai
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarawut Siwamogsatham
- Department of Medicine, Chula Clinical Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-Netherlands Australia Thailand/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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18
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Affiliation(s)
- David C Boettiger
- Institute for Health Policy Studies, University of California, San Francisco, USA.,Kirby Institute, University of New South Wales, Sydney, Australia
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19
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Abstract
Objectives. To estimate the combined effect of California's Tobacco 21 law (enacted June 2016) and $2-per-pack cigarette excise tax increase (enacted April 2017) on cigarette prices and sales, compared with matched comparator states.Methods. We used synthetic control methods to compare cigarette prices and sales after the policies were enacted, relative to what we would have expected without the policy reforms. To estimate the counterfactual, we matched pre-reform covariate and outcome trends between California and control states to construct a "synthetic" California.Results. Compared with the synthetic control in 2018, cigarette prices in California were $1.89 higher ($7.86 vs $5.97; P < .001), and cigarette sales were 16.6% lower (19.9 vs 16.6 packs per capita; P < .001). This reduction in sales equates to 153.9 million fewer packs being sold between 2017 and 2018.Conclusions. California's new cigarette tax was largely passed on to consumers. The new cigarette tax, combined with the Tobacco 21 law, have contributed to a rapid and substantial reduction in cigarette consumption in California.
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Affiliation(s)
- David C Boettiger
- David C. Boettiger is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and the Kirby Institute, University of New South Wales, Sydney, Australia. Justin S. White is with the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Justin S White
- David C. Boettiger is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and the Kirby Institute, University of New South Wales, Sydney, Australia. Justin S. White is with the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics, University of California, San Francisco
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20
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Boettiger DC, Escuder MM, Law MG, Veloso V, Souza RA, Ikeda MLR, deAlencastro PR, Tupinambás U, Brites C, Grinsztejn B, Ggomes JO, Ribeiro S, McGowan CC, Jayathilake K, Castilho JL, Grangeiro A. Cardiovascular disease among people living with HIV in Brazil. Trop Med Int Health 2020; 25:886-896. [PMID: 32306480 PMCID: PMC7547667 DOI: 10.1111/tmi.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil. METHODS Competing risk regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003 and 2014. RESULTS Among 5614 patients, the rate of CVD was 3.5 (95% confidence interval [95% CI] 2.9-4.3) per 1000 person-years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for ≥55 years vs. <35 years, 95% CI: 2.5-16.3, P < 0.01), black race (aHR 1.8 vs. white race, 95% CI: 1.0-3.1, P = 0.04), past CVD (aHR 3.0 vs. no past CVD, 95% CI: 1.4-6.2, P < 0.01), hypertension (aHR 1.8 vs. no hypertension, 95% CI: 1.0-3.1, P = 0.04), high-grade dyslipidemia (aHR 9.3 vs. no high-grade dyslipidemia, 95% CI: 6.0-14.6, P < 0.01), ever smoking (aHR 2.4 vs. never, 95% CI: 1.2-5.0, P = 0.02) and low nadir CD4 cell count (aHR 1.8 for 100-250 cells/mm3 vs. >250 cells/mm3 , 95% CI: 1.0-3.2, P = 0.05). The rate of death was 16.6 (95% CI: 15.1-18.3) per 1000 person-years. Death was strongly associated with having had a past CVD event (aHR 1.7 vs. no past CVD event, 95% CI: 1.1-2.7, P = 0.01). CONCLUSIONS Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.
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Affiliation(s)
- David C. Boettiger
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Matthew G. Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Valdiléa Veloso
- National Institute of Infectology – Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosa A. Souza
- São Paulo State Department of Health, AIDS Reference and Training Center, São Paulo, Brazil
| | - Maria L. R. Ikeda
- School of Health, University do Vale do Rio dos Sinos, Porto Alegre, Brazil
| | - Paulo R. deAlencastro
- Care and Treatment Clinic of the Hospital Sanatório Partenon, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Unai Tupinambás
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carlos Brites
- Edgar Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil
| | - Beatriz Grinsztejn
- National Institute of Infectology – Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jackeline O. Ggomes
- São Paulo State Department of Health, Institute of Health, São Paulo, Brazil
| | - Sayonara Ribeiro
- National Institute of Infectology – Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Catherine C. McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karu Jayathilake
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandre Grangeiro
- Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
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21
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Boettiger DC, Newall AT, Chattranukulchai P, Chaiwarith R, Khusuwan S, Avihingsanon A, Phillips A, Bendavid E, Law MG, Kahn JG, Ross J, Bautista‐Arredondo S, Kiertiburanakul S. Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis. J Int AIDS Soc 2020; 23 Suppl 1:e25494. [PMID: 32562359 PMCID: PMC7305414 DOI: 10.1002/jia2.25494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 03/31/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV-negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. METHODS We developed a discrete-state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid-lowering therapy. The model simulated each individual's probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles over a 20-year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. RESULTS Pravastatin was estimated to be less effective and less cost-effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost-effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness-to-pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost-effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost-effective at an annual cost of 600 Baht ($US19.30)/year. CONCLUSIONS Neither pravastatin nor pitavastatin were projected to be cost-effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.
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Affiliation(s)
- David C Boettiger
- Kirby InstituteUNSW SydneySydneyNSWAustralia
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | | | - Romanee Chaiwarith
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Anchalee Avihingsanon
- The Thai Red Cross AIDS Research Centre and Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonUnited Kingdom
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - James G Kahn
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jeremy Ross
- TREAT Asia/amfAR–Foundation for AIDS ResearchBangkokThailand
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22
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Boettiger DC, Law MG, Ross J, Huy BV, Heng BSL, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong DD, Kumarasamy N, Kamarulzaman A, Ly PS, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee MP, Sangle S, Choi JY, Ku WW, Tanuma J, Ng OT, Sohn AH, Wester CW, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020; 6:11-18. [PMID: 32175086 PMCID: PMC7043905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMICs). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia. METHODS Sixteen LMIC sites included in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific network were surveyed. RESULTS Sites were mostly (81%) based in urban public referral hospitals. Half had protocols to assess tobacco and alcohol use. Protocols for assessing physical inactivity and obesity were in place at 31% and 38% of sites, respectively. Most sites provided educational material on ASCVD risk factors (between 56% and 75% depending on risk factors). A total of 94% reported performing routine screening for hypertension, 100% for hyperlipidaemia and 88% for diabetes. Routine ASCVD risk assessment was reported by 94% of sites. Protocols for the management of hypertension, hyperlipidaemia, diabetes, high ASCVD risk and chronic ischaemic stroke were in place at 50%, 69%, 56%, 19% and 38% of sites, respectively. Blood pressure monitoring was free for patients at 69% of sites; however, most required patients to pay some or all the costs for other ASCVD-related procedures. Medications available in the clinic or within the same facility included angiotensin-converting enzyme inhibitors (81%), statins (94%) and sulphonylureas (94%). CONCLUSION The consistent availability of clinical screening, diagnostic testing and procedures and the availability of ASCVD medications in the Asian LMIC clinics surveyed are strengths that should be leveraged to improve the implementation of cardiovascular care protocols.
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Affiliation(s)
- DC Boettiger
- Kirby Institute,
UNSW Sydney,
Australia,Institute for Health Policy Studies,
University of California, San Francisco,
USA,Corresponding author: David C Boettiger
Institute for Health Policy Studies,
University of California, San Francisco,
3333 California Street,
94118,
USA
| | - MG Law
- Kirby Institute,
UNSW Sydney,
Australia
| | - J Ross
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - BV Huy
- National Hospital for Tropical Disease,
Hanoi,
Vietnam
| | - BSL Heng
- Hospital Sungai Buloh,
Kuala Lumpur,
Malaysia
| | - R Ditangco
- Research Institute for Tropical Medicine,
Manila,
Philippines
| | | | - A Avihingsanon
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - DD Cuong
- Bach Mai Hospital,
Hanoi,
Vietnam
| | - N Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services,
Chennai,
India
| | - A Kamarulzaman
- University Malaya Medical Centre,
Kuala Lumpur,
Malaysia
| | - PS Ly
- Social Health Clinic,
National Center for HIV/AIDS, Dermatology and STDs,
Phnom Penh,
Cambodia
| | - E Yunihastuti
- Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo General Hospital,
Jakarta,
Indonesia
| | | | - F Zhang
- Beijing Ditan Hospital,
Capital Medical University,
Beijing,
China
| | - S Khusuwan
- Chiangrai Prachanukhor Hospital,
Chiangrai,
Thailand
| | - R Chaiwarith
- Research Institute for Health Sciences,
Chiangmai,
Thailand
| | - MP Lee
- Queen Elizabeth Hospital,
Hong Kong
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospitals,
Pune,
India
| | - JY Choi
- Severance Hospital,
Seoul,
South Korea
| | - WW Ku
- Taipei Veterans General Hospital,
Taipei,
Taiwan
| | - J Tanuma
- National Center for Global Health and Medicine,
Tokyo,
Japan
| | - OT Ng
- Tan Tock Seng Hospital,
Singapore
| | - AH Sohn
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - CW Wester
- Vanderbilt University Medical Center,
Institute for Global Health,
Nashville,
USA
| | - D Nash
- Institute for Implementation Science in Population Health,
City University of New York,
New York,
USA,Department of Epidemiology and Biostatistics,
City University of New York,
New York,
USA
| | - C Mugglin
- Institute of Social and Preventative Medicine,
University of Bern,
Switzerland
| | - S Pujari
- Institute for Infectious Diseases,
Pune,
India
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23
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Sudjaritruk T, Boettiger DC, Nguyen LV, Mohamed TJ, Wati DK, Bunupuradah T, Hansudewechakul R, Ly PS, Lumbiganon P, Nallusamy RA, Fong MS, Chokephaibulkit K, Nik Yusoff NK, Truong KH, Do VC, Sohn AH, Sirisanthana V. Impact of the frequency of plasma viral load monitoring on treatment outcomes among children with perinatally acquired HIV. J Int AIDS Soc 2019; 22:e25312. [PMID: 31179641 PMCID: PMC6556679 DOI: 10.1002/jia2.25312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/09/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Recommendations on the optimal frequency of plasma viral load (pVL) monitoring in children living with HIV (CLWH) who are stable on combination antiretroviral therapy (cART) are inconsistent. This study aimed to determine the impact of annual versus semi-annual pVL monitoring on treatment outcomes in Asian CLWH. METHODS Data on children with perinatally acquired HIV aged <18 years on first-line, non-nucleoside reverse transcriptase inhibitor-based cART with viral suppression (two consecutive pVL <400 copies/mL over a six-month period) were included from a regional cohort study; those exposed to prior mono- or dual antiretroviral treatment were excluded. Frequency of pVL monitoring was determined at the site-level based on the median rate of pVL measurement: annual 0.75 to 1.5, and semi-annual >1.5 tests/patient/year. Treatment failure was defined as virologic failure (two consecutive pVL >1000 copies/mL), change of antiretroviral drug class, or death. Baseline was the date of the second consecutive pVL <400 copies/mL. Competing risk regression models were used to identify predictors of treatment failure. RESULTS During January 2008 to March 2015, there were 1220 eligible children from 10 sites that performed at least annual pVL monitoring, 1042 (85%) and 178 (15%) were from sites performing annual (n = 6) and semi-annual pVL monitoring (n = 4) respectively. Pre-cART, 675 children (55%) had World Health Organization clinical stage 3 or 4, the median nadir CD4 percentage was 9%, and the median pVL was 5.2 log10 copies/mL. At baseline, the median age was 9.2 years, 64% were on nevirapine-based regimens, the median cART duration was 1.6 years, and the median CD4 percentage was 26%. Over the follow-up period, 258 (25%) CLWH with annual and 40 (23%) with semi-annual pVL monitoring developed treatment failure, corresponding to incidence rates of 5.4 (95% CI: 4.8 to 6.1) and 4.3 (95% CI: 3.1 to 5.8) per 100 patient-years of follow-up respectively (p = 0.27). In multivariable analyses, the frequency of pVL monitoring was not associated with treatment failure (adjusted hazard ratio: 1.12; 95% CI: 0.80 to 1.59). CONCLUSIONS Annual compared to semi-annual pVL monitoring was not associated with an increased risk of treatment failure in our cohort of virally suppressed children with perinatally acquired HIV on first-line NNRTI-based cART.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Department of PediatricsFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | | | | | - Dewi K Wati
- Sanglah HospitalUdayana UniversityBaliIndonesia
| | | | | | - Penh S Ly
- National Centre for HIV/AIDS, Dermatology and STDsPhnom PenhCambodia
| | - Pagakrong Lumbiganon
- Department of PediatricsFaculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | | | | | | | | | | | - Viet C Do
- Children's Hospital 2Ho Chi Minh CityVietnam
| | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Virat Sirisanthana
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
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24
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Boettiger DC, Law MG, Sohn AH, Davies MA, Wools-Kaloustian K, Leroy V, Yotebieng M, Vinikoor M, Vreeman R, Amorissani-Folquet M, Edmonds A, Fatti G, Batte J, Renner L, Adedimeji A, Kariminia A. Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency. J Pediatric Infect Dis Soc 2018; 8:450-460. [PMID: 30215763 PMCID: PMC6831936 DOI: 10.1093/jpids/piy087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/10/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Co-trimoxazole is recommended for all children with human immunodeficiency virus. In this analysis, we evaluate trends in pediatric co-trimoxazole use and survival on co-trimoxazole in children using antiretroviral therapy (ART). METHODS We used data collected between January 1, 2006, and March 31, 2016, from the International Epidemiology Databases to Evaluate AIDS. Logistic regression was used to evaluate factors associated with using co-trimoxazole at ART initiation. Competing risk regression was used to assess factors associated with death. RESULTS A total of 54113 children were included in this study. The prevalence of co-trimoxazole use at ART initiation increased from 66.5% in 2006 to a peak of 85.6% in 2010 and then declined to 48.5% in 2015-2016. A similar trend was observed among children who started ART with severe immunodeficiency. After adjusting for year of ART initiation, younger age (odds ratio [OR], 1.18 for <1 vs 1 to <5 years of age [95% confidence interval (CI), 1.09-1.28]), lower height-for-age z score (OR, 1.15 for less than -3 vs greater than -2 [95% CI, 1.08-1.22]), anemia (OR, 1.08 [95% CI, 1.02-1.15]), severe immunodeficiency (OR, 1.25 [95% CI, 1.18-1.32]), and receiving care in East Africa (OR, 8.97 vs Southern Africa [95% CI, 8.17-9.85]) were associated with a high prevalence of co-trimoxazole use. Survival did not differ according to co-trimoxazole use in children without severe immunodeficiency (hazard ratio, 1.01 for nonusers versus users [95% CI, 0.77-1.34]). CONCLUSIONS Recent declines in co-trimoxazole use may not be linked to the current shift toward early ART initiation. Randomized trial data might be needed to establish the survival benefit of co-trimoxazole in children without severe immunodeficiency.
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Affiliation(s)
- David C Boettiger
- The Kirby Institute, University of New South Wales, Sydney, Australia,Correspondence: D. C. Boettiger, Wallace Wurth Building, UNSW, Sydney, NSW 2252, Australia ()
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Annette H Sohn
- TREAT Asia/amfAR–Foundation for AIDS Research, Bangkok, Thailand
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Valeriane Leroy
- INSERM, Laboratoire d’Epidémiologie et Analyses en Santé Publique (LEASP)–UMR 1027, Toulouse, France
| | | | - Michael Vinikoor
- Department of Medicine, University of North Carolina at Chapel Hill,Centre for Infectious Disease Research in Zambia, Lusaka
| | | | | | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Geoffrey Fatti
- Kheth’Impilo AIDS Free Living, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | - Lorna Renner
- Department of Paediatrics, Korlebu Hospital, Accra, Ghana
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
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25
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Boettiger DC, Law MG, Dore GJ, Guy R, Callander D, Donovan B, O’Connor CC, Fairley CK, Hellard M, Matthews G. Hepatitis C testing and re-testing among people attending sexual health services in Australia, and hepatitis C incidence among people with human immunodeficiency virus: analysis of national sentinel surveillance data. BMC Infect Dis 2017; 17:740. [PMID: 29191154 PMCID: PMC5709850 DOI: 10.1186/s12879-017-2848-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Direct acting antivirals are expected to drastically reduce the burden of hepatitis C virus (HCV) in people living with Human Immunodeficiency Virus (HIV). However, rates of HCV testing, re-testing and incident infection in this group remain uncertain in Australia. We assessed trends in HCV testing, re-testing and incident infection among HIV-positive individuals, and evaluated factors associated with HCV re-testing and incident infection. METHODS The study population consisted of HIV-positive individuals who visited a sexual health service involved in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) between 2007 and 2015. Poisson regression was used to assess trends and to evaluate factors associated with HCV re-testing and incident HCV infection. RESULTS There were 9227 HIV-positive individuals included in our testing rate analysis. Of 3799 HIV-positive/HCV-negative people that attended an ACCESS sexual health service more than once, 2079 (54.7%) were re-tested for HCV and were therefore eligible for our incidence analysis. The rate of HCV testing increased from 17.1 to 51.4 tests per 100 patient years between 2007 and 2015 (p for trend <0.01). Over the same period, HCV re-testing rates increased from 23.9 to 79.7 tests per 100 person years (p for trend <0.01). A clear increase in testing and re-testing began after 2011. Patients who identified as men who have sex with men and those with a history of injecting drug use experienced high rates of HCV re-testing over the course of the study period. Among those who re-tested, 157 incident HCV infections occurred at a rate of 2.5 events per 100 person years. Between 2007 and 2009, 2010-2011, 2012-2013 and 2014-2015, rates of incident HCV were 0.8, 1.5, 3.9 and 2.7 events per 100 person years, respectively (p for trend <0.01). Incident HCV was strongly associated with a history of injecting drug use. CONCLUSIONS High rates of HCV testing and re-testing among HIV-positive individuals in Australia will assist strategies to achieve HCV elimination through rapid treatment scale up. Continued monitoring of HCV incidence in this population is essential for guiding both HCV prevention and treatment strategies.
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Affiliation(s)
| | | | | | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
- Sydney Sexual Health Centre, Sydney, NSW Australia
| | - Catherine C. O’Connor
- The Kirby Institute, UNSW Sydney and Sexual Health Service, Sydney Local Health District, Sydney, NSW Australia
- Central Clinical School, Sydney University, Sydney, NSW Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health and Monash University, Melbourne, Victoria Australia
| | - Margaret Hellard
- Viral Hepatitis Elimination Program, Burnet Institute, Melbourne, Victoria Australia
| | - Gail Matthews
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Sudjaritruk T, Aurpibul L, Ly PS, Le TPK, Bunupuradah T, Hansudewechakul R, Lumbiganon P, Chokephaibulkit K, Yusoff NKN, Van Nguyen L, Razali KAM, Fong MS, Nallusamy RA, Kurniati N, Do VC, Boettiger DC, Sohn AH, Kariminia A. Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy. J Adolesc Health 2017; 61:91-98. [PMID: 28343759 PMCID: PMC5483211 DOI: 10.1016/j.jadohealth.2017.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the incidence and predictors of postsuppression virologic rebound (VR) among adolescents on stable combination antiretroviral therapy in Asia. METHODS Perinatally HIV-infected Asian adolescents (10-19 years) with documented virologic suppression (two consecutive viral loads [VLs] <400 copies/mL ≥6 months apart) were included. Baseline was the date of the first VL <400 copies/mL at age ≥10 years or the 10th birthday for those with prior suppression. Cox proportional hazards models were used to identify predictors of postsuppression VR (VL >1,000 copies/mL). RESULTS Of 1,379 eligible adolescents, 47% were males. At baseline, 22% were receiving protease inhibitor-containing regimens; median CD4 cell count (interquartile range [IQR]) was 685 (448-937) cells/mm3; 2% had preadolescent virologic failure (VF) before subsequent suppression. During adolescence, 180 individuals (13%) experienced postsuppression VR at a rate of 3.4 (95% confidence interval: 2.9-3.9) per 100 person-years, which was consistent over time. Median time to VR during adolescence (IQR) was 3.3 (2.1-4.8) years. Wasting (weight-for-age z-score <-2.5), being raised by grandparents, receiving second-line protease inhibitor-based regimens, starting combination antiretroviral therapy after 2005, and having preadolescent VF were independent predictors of adolescent VR. At VR, median age, CD4 cell count, and VL (IQR) were 14.8 (13.2-16.4) years, 507 (325-723) cells/mm3, and 4.1 (3.5-4.7) log10 copies/mL, respectively. CONCLUSIONS A modest and consistent incidence of postsuppression VR was documented during adolescence in our cohort. Having poor weight, receiving second-line regimens, and prior VF were associated with an increased VR rate. Adolescents at higher risk of VR may benefit from more intensive VL monitoring to enhance adherence management.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | | | | | | | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Annette H. Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research, Bangkok, Thailand
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Kosalaraksa P, Boettiger DC, Bunupuradah T, Hansudewechakul R, Saramony S, Do VC, Sudjaritruk T, Yusoff NKN, Razali KAM, Nguyen LV, Nallusamy R, Fong SM, Kurniati N, Truong KH, Sohn AH, Chokephaibulkit K. Low Risk of CD4 Decline After Immune Recovery in Human Immunodeficiency Virus-Infected Children With Viral Suppression. J Pediatric Infect Dis Soc 2017; 6:173-177. [PMID: 27295973 PMCID: PMC6251660 DOI: 10.1093/jpids/piw031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/09/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND. Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load. METHODS Study end points were as follows: (1) a CD4 count <200 cells/mm3 followed by a CD4 count ≥200 cells/mm3 (transient CD4 <200); (2) CD4 count <200 cells/mm3 confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure). Kaplan-Meier curves and Cox regression were used to evaluate rates and predictors of transient CD4 <200, confirmed CD4 <200, and clinical failure among virally suppressed children aged 5-15 years who were enrolled in the TREAT Asia Pediatric HIV Observational Database. RESULTS Data from 967 children were included in the analysis. At the time of confirmed viral suppression, median age was 10.2 years, 50.4% of children were female, and 95.4% were perinatally infected with HIV. Median CD4 cell count was 837 cells/mm3, and 54.8% of children were classified as having WHO stage 3 or 4 disease. In total, 18 transient CD4 <200 events, 2 confirmed CD4 <200 events, and10 clinical failures occurred at rates of 0.73 (95% confidence interval [95% CI], 0.46-1.16), 0.08 (95% CI, 0.02-0.32), and 0.40 (95% CI, 0.22-0.75) events per 100 patient-years, respectively. CD4 <500 cells/mm3 at the time of viral suppression confirmation was associated with higher rates of both CD4 outcomes. CONCLUSIONS Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.
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Affiliation(s)
- Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand;
| | | | - Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, and
| | | | | | - Viet C. Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam;
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Thailand;
| | | | | | | | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia;
| | | | | | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Boettiger DC, Muktiarti D, Kurniati N, Truong KH, Saghayam S, Ly PS, Hansudewechakul R, Van Nguyen L, Do VC, Sudjaritruk T, Lumbiganon P, Chokephaibulkit K, Bunupuradah T, Nik Yusoff NK, Wati DK, Mohd Razali KA, Fong MS, Nallusamy RA, Sohn AH, Kariminia A. Early Height and Weight Changes in Children Using Cotrimoxazole Prophylaxis With Antiretroviral Therapy. Clin Infect Dis 2016; 63:1236-1244. [PMID: 27470239 DOI: 10.1093/cid/ciw514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The growth benefits of cotrimoxazole during early antiretroviral therapy (ART) are not well characterized. METHODS Individuals enrolled in the Therapeutics Research, Education, and AIDS Training in Asia Pediatric HIV Observational Database were included if they started ART at ages 1 month-14 years and had both height and weight measurements available at ART initiation (baseline). Generalized estimating equations were used to identify factors associated with change in height-for-age z-score (HAZ), follow-up HAZ ≥ -2, change in weight-for-age z-score (WAZ), and follow-up WAZ ≥ -2. RESULTS A total of 3217 children were eligible for analysis. The adjusted mean change in HAZ among cotrimoxazole and non-cotrimoxazole users did not differ significantly over the first 24 months of ART. In children who were stunted (HAZ < -2) at baseline, cotrimoxazole use was not associated with a follow-up HAZ ≥ -2. The adjusted mean change in WAZ among children with a baseline CD4 percentage (CD4%) >25% became significantly different between cotrimoxazole and non-cotrimoxazole users after 6 months of ART and remained significant after 24 months (overall P < .01). Similar changes in WAZ were observed in those with a baseline CD4% between 10% and 24% (overall P < .01). Cotrimoxazole use was not associated with a significant difference in follow-up WAZ in children with a baseline CD4% <10%. In those underweight (WAZ < -2) at baseline, cotrimoxazole use was associated with a follow-up WAZ ≥ -2 (adjusted odds ratio, 1.70 vs not using cotrimoxazole [95% confidence interval, 1.28-2.25], P < .01). This association was driven by children with a baseline CD4% ≥10%. CONCLUSIONS Cotrimoxazole use is associated with benefits to WAZ but not HAZ during early ART in Asian children.
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Affiliation(s)
- David C Boettiger
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Suneeta Saghayam
- Y.R. Gaitonde Center for AIDS Research and Education Medical Centre, Chennai, India
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | | | | | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai
| | | | | | - Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Boettiger DC, Khol V, Durier N, Law M, Sun LP. HIV viral suppression in TREAT Asia HIV Observational Database enrolled adults on antiretroviral therapy at the Social Health Clinic, the National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia. Antivir Ther 2016; 21:725-730. [PMID: 27124891 DOI: 10.3851/imp3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Social Health Clinic at the National Center for HIV/AIDS, Dermatology & STDs (SHC-NCHADS) in Phnom Penh is a major provider of antiretroviral therapy (ART) in Cambodia. However, patient access to viral load monitoring is uncommon. We conducted a cross-sectional evaluation of HIV viral load in SHC-NCHADS patients on ART to determine the proportion experiencing virological failure and to identify factors associated with virological failure in this population. METHODS Patients who had been using their current first- or second-line ART regimen for ≥6 months were eligible. Virological failure was defined as a viral load >1,000 copies/ml, death, lost-to-follow-up or the absence of viral load testing despite presenting for care. Factors associated with virological failure were evaluated using logistic regression. RESULTS Overall, 463 patients (53.1% male, median age 42.1 years) were included in the investigation. At the time of current regimen initiation, median CD4+ T-cell count was 101 cells/mm3 and 89.0% of patients had experienced a WHO stage III/IV event. At the time of testing/last clinic visit, 28 (6.0%) patients met our definition of virological failure. Median viral load among those failing was 9,633 copies/ml. Shorter time on current ART regimen, low CD4+ T-cell count at the time of viral load testing/last clinic visit and a record of suboptimal adherence were the strongest predictors of virological failure. CONCLUSIONS This work demonstrates the high rate of viral suppression being achieved by the treatment programme at SHC-NCHADS and the need for future work to phase-in routine viral load monitoring in Cambodia.
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Affiliation(s)
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Nicolas Durier
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Ly Penh Sun
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
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Boettiger DC, Sudjaritruk T, Nallusamy R, Lumbiganon P, Rungmaitree S, Hansudewechakul R, Kumarasamy N, Bunupuradah T, Saphonn V, Truong HK, Yusoff NKN, Do CV, Nguyen LV, Razali KAM, Fong SM, Kurniati N, Kariminia A. Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia. J Adolesc Health 2016; 58:451-459. [PMID: 26803201 PMCID: PMC4808326 DOI: 10.1016/j.jadohealth.2015.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. METHODS Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL. RESULTS Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure. CONCLUSIONS Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.
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Affiliation(s)
- David C Boettiger
- Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
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Boettiger DC, Kerr S, Ditangco R, Chaiwarith R, Li PC, Merati TP, Pham TTT, Kiertiburanakul S, Kumarasamy N, Vonthanak S, Lee CK, Van Kinh N, Pujari S, Wong WW, Kamarulzaman A, Zhang F, Yunihastuti E, Choi JY, Oka S, Ng OT, Kantipong P, Mustafa M, Ratanasuwan W, Durier N, Law M. Tenofovir-based antiretroviral therapy in
HBV-HIV coinfection: results from the TREAT Asia HIV Observational Database. Antivir Ther 2015; 21:27-35. [PMID: 26069150 DOI: 10.3851/imp2972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The World Health Organization recommends HBV-HIV-coinfected individuals start antiretroviral therapy containing tenofovir. Here we describe first-line tenofovir use and treatment outcomes in coinfected patients in Asia. METHODS HBV surface antigen positive patients enrolled in the TREAT Asia HIV Observational Database who started first-line antiretroviral therapy were included. Logistic regression adjusted for period of treatment initiation was used to determine factors associated with tenofovir use. Generalized estimating equations were used to evaluate factors associated with alanine transaminase levels and CD4(+) T-cell count on treatment. RESULTS There were 548 eligible patients, of whom 149 (27.2%) started tenofovir. Patients treated in high/high-middle income countries (odds ratio 4.4 versus low/low-middle, 95% CI 2.6, 7.4; P<0.001) and those with elevated baseline alanine transaminase (odds ratio 4.2 versus normal, 95% CI 2.4, 7.2; P<0.001) were more likely to receive tenofovir. Hepatitis C antibody positive patients (odds ratio 0.4 versus negative, 95% CI 0.2, 0.8; P=0.008) were less likely. In those starting antiretroviral therapy with elevated alanine transaminase, mean reduction after tenofovir initiation was 11.2 IU/l (95% CI 0.9, 21.6; P=0.034) lower compared with those using a non-tenofovir-based regimen although this did not significantly increase the chance of alanine transaminase normalization. Tenofovir use was not associated with a superior CD4(+) T-cell response. CONCLUSIONS HBV-HIV-coinfected patients in Asia are most likely to receive tenofovir if they are treated in a high/high-middle income country, have elevated alanine transaminase levels and are hepatitis C antibody negative. Compared to other antiretroviral therapies, tenofovir-based regimens more effectively reduce liver inflammation in HBV-HIV-coinfection but do not result in superior CD4(+) T-cell recovery.
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Boettiger DC, Nguyen VK, Durier N, Bui HV, Heng Sim BL, Azwa I, Law M, Ruxrungtham K. Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: results from the TREAT Asia HIV observational database. J Acquir Immune Defic Syndr 2015; 68:186-95. [PMID: 25590271 PMCID: PMC4296907 DOI: 10.1097/qai.0000000000000411] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources, it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. METHODS HIV-positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. RESULTS There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells per cubic millimeter, and median HIV viral load was 16,224 copies per milliliter. Patients started second-line ART before 2007 (n = 105), 2007-2010 (n = 147) and after 2010 (n = 50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line therapy was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95% confidence interval: 7.1 to 10.9) and 1.1 (95% confidence interval: 0.6 to 1.9), respectively. Older age, high baseline viral load, and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. CONCLUSIONS Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.
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Affiliation(s)
- David C Boettiger
- *Biostatistics and Databases Program, The Kirby Institute, UNSW Australia, Sydney, Australia; †National Hospital of Tropical Diseases, Hanoi, Vietnam; ‡TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand; §Infectious Diseases Unit, Department of Medicine, Hospital Sungai Buloh, Sungai Buloh, Malaysia; ‖Faculty of Medicine, Infectious Diseases Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; and ¶HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Boettiger DC, Saphonn V, Lee MP, Phanuphak P, Pham TT, Heng Sim BL, Kumarasamy N, Van Nguyen K, Kantipong P, Kamarulzaman A, Chaiwarith R, Kiertiburanakul S, Law MG. A clinical prediction tool for targeted pre-antiretroviral therapy creatinine testing applied to the TREAT Asia HIV observational database cohort. J Acquir Immune Defic Syndr 2014; 67:e131-3. [PMID: 25197829 PMCID: PMC4213211 DOI: 10.1097/qai.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David C Boettiger
- *The Kirby Institute, UNSW Australia, Sydney, Australia †National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia ‡Queen Elizabeth Hospital, Hong Kong, China §HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand ‖Bach Mai Hospital, Hanoi, Vietnam ¶Hospital Sungai Buloh, Sungai Buloh, Malaysia #YRGCARE Medical Centre, VHS, Chennai, India **National Hospital for Tropical Diseases, Hanoi, Vietnam ††Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand ‡‡University Malaya Medical Centre, Kuala Lumpur, Malaysia §§Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand ‖‖Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Boettiger DC, Kiertiburanakul S, Sungkanuparph S, Law MG. The impact of wild-type reversion on transmitted resistance surveillance. Antivir Ther 2014; 19:719-22. [PMID: 24535375 DOI: 10.3851/imp2746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Affiliation(s)
- David C Boettiger
- Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, New South Wales, Australia.
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