International Epidemiologic Databases to Evaluate AIDS
Mary-Anne Davies, Principal Investigator
University of Cape Town, South Africa
Southern Africa is where almost 30 of the approximately 40 million HIV-infected people in the world live, in an area estimated to have 2 of the global population. While an estimated 2 million men, women, and children are yet in urgent need of antiretroviral treatment in this region, close to 200,000 individuals are now believed by the World Health Organization to be receiving treatment. Answers are urgently needed to clinical and operational research questions regarding the most effective implementation and monitoring of wide-scale antiretroviral treatment delivery.
Research Design and Methods:
The OASIS Collaboration includes 17 clinics and clinical cohorts in 6 countries in the region, involving 35,070 HIV-1 infected adults and children. We will use innovative and state-of-the-art statistical approaches to analyze data from this observational cohort study, including techniques which account for the longitudinal and hierarchical structure of the data. An operational structure is proposed that emphasizes the long-term collaborative and capacity-building approach of the collaboration.
BACKGROUND: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally.
BACKGROUND: The cost-effectiveness of routine viral load (VL) monitoring of HIV-infected patients on antiretroviral therapy (ART) depends on various factors that differ between settings and across time. Low-cost point-of-care (POC) tests for VL are in development and may make routine VL monitoring affordable in resource-limited settings. We developed a software tool to study the cost-effectiveness of switching to second-line ART with different monitoring strategies, and focused on POC-VL monitoring.
BACKGROUND: Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral therapy (ART). We aimed to construct normative curves for weight gain at 6, 12, 18, and 24 months following initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART.
BACKGROUND: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries.
INTRODUCTION: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide.
BACKGROUND: The risk of Kaposi sarcoma (KS) among HIV-infected persons on antiretroviral therapy (ART) is not well defined in resource-limited settings. We studied KS incidence rates and associated risk factors in children and adults on ART in Southern Africa.