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

C. William Wester, John R. Koethe, Bryan E. Shepherd, Samuel E. Stinnette, Peter F. Rebeiro, Aaron M. Kipp, Hwanhee Hong, Hermann Bussmann, Tendani Gaolathe, Catherine C. McGowan, Timothy R. Sterling, Richard G. Marlink

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Objective: To compare incidence and distribution of non-AIDS-defining events (NADEs) among HIV-1-infected adults receiving combination antiretroviral therapy (cART) in urban sub-Saharan African versus United States settings. Design: Retrospective cohort analysis of clinical trial and observational data. Methods: Compared crude and standardized (to US cohort by age and sex) NADE rates from two urban adult HIV-infected cART-initiating populations: a clinical trial cohort in Gaborone, Botswana (Botswana) and an observational cohort in Nashville, Tennessee (USA). Results: Crude NADE incidence rates were similar: 10.0 [95% confidence interval 6.3-15.9] per 1000 person-years in Botswana versus 12.4 [8.4-18.4] per 1000 person-years in the United States. However, after standardizing to an older, predominantly male US population, the overall NADE incidence rates were higher in Botswana [18.7 (8.3-33.1) per 1000 person-years]. Standardized rates differed most for cardiovascular events (8.4 versus 5.0 per 1000 person-years) and non-AIDS-defining malignancies (8.0 versus 0.5 per 1000 person-years)-both higher in Botswana. Conversely, hepatic NADE rates were higher in the United States (4.0 versus 0.0 per 1000 person-years), whereas renal NADE rates [3.0 per 1000 person-years (United States) versus 2.4 per 1000 person-years (Botswana)] were comparable. Conclusion: Crude NADE incidence rates were similar between cART-treated patients in a US observational cohort and a sub-Saharan African clinical trial. However, when standardized to the US cohort, overall NADE rates were higher in Botswana. NADEs appear to be a significant problem in our sub-Saharan African setting, and the monitoring, prevention, and treatment of NADEs should be a critical component of care in resource-limited settings.

Original languageEnglish (US)
Pages (from-to)1471-1479
Number of pages9
JournalAIDS
Volume25
Issue number12
DOIs
StatePublished - Jul 31 2011
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Keywords

  • HIV/AIDS
  • combination antiretroviral therapy
  • non-AIDS-defining events
  • urban United States
  • urban sub-Saharan Africa

Fingerprint

Dive into the research topics of 'Non-AIDS-defining events among HIV-1-infected adults receiving combination antiretroviral therapy in resource-replete versus resource-limited urban setting'. Together they form a unique fingerprint.

Cite this