• Cytomegalovirus retinitis: the neglected disease of the AIDS pandemic.

      Heiden, D; Ford, N; Wilson, D; Rodriguez, W; Margolis, T; Janssens, B; Bedelu, M; Tun, N; Goemaere, E; Saranchuk, P; et al. (PLoS, 2007-12)
    • Diagnostic value of the urine lipoarabinomannan assay in HIV-positive, ambulatory patients with CD4 below 200 cells/μl in 2 low-resource settings: A prospective observational study.

      Huerga, H; Mathabire Rucker, SC; Cossa, L; Bastard, M; Amoros, I; Manhica, I; Mbendera, K; Telnov, A; Szumilin, E; Sanchez-Padilla, E; et al. (Public Library of Science, 2019-04-30)
      BACKGROUND: Current guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/μl. We assessed the diagnostic yield of including LAM in TB diagnostic algorithms in HIV-positive, ambulatory patients with CD4 < 200 cells/μl, as well as the risk of mortality in LAM-positive patients who were not diagnosed using other diagnostic tools and not treated for TB. METHODS AND FINDINGS: We conducted a prospective observational study including HIV-positive adult patients with signs and symptoms of TB and CD4 < 200 cells/μl attending 6 health facilities in Malawi and Mozambique. Patients were included consecutively from 18 September 2015 to 27 October 2016 in Malawi and from 3 December 2014 to 22 August 2016 in Mozambique. All patients had a clinical exam and LAM, chest X-ray, sputum microscopy, and Xpert MTB/RIF assay (Xpert) requested. Culture in sputum was done for a subset of patients. The diagnostic yield was defined as the proportion of patients with a positive assay result among those with laboratory-confirmed TB. For the 456 patients included in the study, the median age was 36 years (IQR 31-43) and the median CD4 count was 50 cells/μl (IQR 21-108). Forty-five percent (205/456) of the patients had laboratory-confirmed TB. The diagnostic yields of LAM, microscopy, and Xpert were 82.4% (169/205), 33.7% (69/205), and 40.0% (84/205), respectively. In total, 50.2% (103/205) of the patients with laboratory-confirmed TB were diagnosed only through LAM. Overall, the use of LAM in diagnostic algorithms increased the yield of algorithms with microscopy and with Xpert by 38.0% (78/205) and 34.6% (71/205), respectively, and, specifically among patients with CD4 100-199 cells/μl, by 27.5% (14/51) and 29.4% (15/51), respectively. LAM-positive patients not diagnosed through other tools and not treated for TB had a significantly higher risk of mortality than LAM-positive patients who received treatment (adjusted risk ratio 2.57, 95% CI 1.27-5.19, p = 0.009). Although the TB diagnostic conditions in the study sites were similar to those in other resource-limited settings, the added value of LAM may depend on the availability of microscopy or Xpert results. CONCLUSIONS: LAM has diagnostic value for identifying TB in HIV-positive patients with signs and symptoms of TB and advanced immunodeficiency, including those with a CD4 count of 100-199 cells/μl. In this study, the use of LAM enabled the diagnosis of TB in half of the patients with confirmed TB disease; without LAM, these patients would have been missed. The rapid identification and treatment of TB enabled by LAM may decrease overall mortality risk for these patients.
    • Emerging priorities for HIV service delivery

      Ford, N; Geng, E; Ellman, T; Orrell, C; Ehrenkranz, P; Sikazwe, I; Jahn, A; Rabkin, M; Ayisi Addo, S; Grimsrud, A; et al. (Public Library of Science, 2020-02-14)
      Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention and treatment services.
    • The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis

      Slogrove, AL; Schomaker, M; Davies, MA; Williams, P; Balkan, S; Ben-Farhat, J; Calles, N; Chokephaibulkit, K; Duff, C; Eboua, TF; et al. (Public Library of Science, 2018-03-01)
      Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.
    • Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study.

      Cornell, Morna; Schomaker, Michael; Garone, Daniela Belen; Giddy, Janet; Hoffmann, Christopher J; Lessells, Richard; Maskew, Mhairi; Prozesky, Hans; Wood, Robin; Johnson, Leigh F; et al. (2012-09)
      Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART.
    • HIV prevention, care, and treatment in two prisons in Thailand.

      Wilson, D; Ford, N; Ngammee, V; Chua, A; Kyaw, M K K; Médecins Sans Frontières, Bangkapi, Bangkok, Thailand. (Public Library of Science, 2007-06)
    • HIV treatment in a conflict setting: outcomes and experiences from Bukavu, Democratic Republic of the Congo.

      Culbert, H; Tu, D; O'Brien, D; Ellman, T; Mills, C; Ford, N; Amisi, T; Chan, K; Venis, S; Médecins Sans Frontières-Holland, Amsterdam, The Netherlands. (Public Library of Science, 2007-05)
    • Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies

      Johnson, Leigh F; Mossong, Joel; Dorrington, Rob E; Schomaker, Michael; Hoffmann, Christopher J; Keiser, Olivia; Fox, Matthew P; Wood, Robin; Prozesky, Hans; Giddy, Janet; et al. (Public Library of Science, 2013-04-09)
      Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults.
    • The missed potential of CD4 and viral load testing to improve clinical outcomes for people living with HIV in lower-resource settings.

      Ehrenkranz, PD; Baptiste, SL; Bygrave, H; Ellman, T; Doi, N; Grimsrud, A; Jahn, A; Kalua, T; Nyirenda, RK; Odo, MO; et al. (Public Library of Science, 2019-05-29)
    • Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America: A Collaborative Analysis of Prospective Studies

      Boulle, Andrew; Schomaker, Michael; May, Margaret T; Hogg, Robert S; Shepherd, Bryan E; Monge, Susana; Keiser, Olivia; Lampe, Fiona C; Giddy, Janet; Ndirangu, James; et al. (2014-09-09)
      High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America.
    • Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared.

      Keiser, O; Orrell, C; Egger, M; Wood, R; Brinkhof, M W G; Furrer, H; Van Cutsem, G; Ledergerber, B; Boulle, A; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. (PLoS, 2008-07-08)
      BACKGROUND: The provision of highly active antiretroviral therapy (HAART) in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialized countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. We compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland. METHODS AND FINDINGS: We analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. We included treatment-naïve patients aged 16 y or older who had started treatment with at least three drugs since 2001, and excluded intravenous drug users. Data from a total of 2,348 patients from South Africa and 1,016 patients from the Swiss HIV Cohort Study were analysed. Median baseline CD4+ T cell counts were 80 cells/mul in South Africa and 204 cells/mul in Switzerland. In South Africa, patients started with one of four first-line regimens, which was subsequently changed in 514 patients (22%). In Switzerland, 36 first-line regimens were used initially, and these were changed in 539 patients (53%). In most patients HIV-1 RNA was suppressed to 500 copies/ml or less within one year: 96% (95% confidence interval [CI] 95%-97%) in South Africa and 96% (94%-97%) in Switzerland, and 26% (22%-29%) and 27% (24%-31%), respectively, developed viral rebound within two years. Mortality was higher in South Africa than in Switzerland during the first months of HAART: adjusted hazard ratios were 5.90 (95% CI 1.81-19.2) during months 1-3 and 1.77 (0.90-3.50) during months 4-24. CONCLUSIONS: Compared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are required in South Africa to both achieve more timely access to HAART and improve the prognosis of patients who start HAART with advanced disease.
    • Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

      Sabapathy, Kalpana; Van den Bergh, Rafael; Fidler, Sarah; Hayes, Richard; Ford, Nathan; London School of Hygiene and Tropical Medicine, London, UK. kalpana.sabapathy@lshtm.ac.uk (2012-12-04)
      Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.
    • Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi.

      Douglas, Gerald P; Gadabu, Oliver J; Joukes, Sabine; Mumba, Soyapi; McKay, Michael V; Ben-Smith, Anne; Jahn, Andreas; Schouten, Erik J; Landis Lewis, Zach; van Oosterhout, Joep J; et al. (2010-09)