that therapy is started promptly, South Africans with HIV have chances of
remaining alive beyond 2 years on antiretroviral therapy (ART) that are
comparable to those of North American patients, according to new research in PLOS
Medicine by Andrew Boulle of the University of Cape Town and colleagues.
Comparison with US and Europe
researchers compared survival data from 4 cohorts in South Africa (30,467
adults), 6 in North America (7,160 adults), and 9 in Europe (29,727 adults) in
which individuals were followed for up to 4 years after starting ART.
correcting for under-ascertainment of mortality in patients who were lost to
cohort follow up in South Africa through linkage to a population register, the
researchers found that South African cohorts had higher mortality than North American or European
cohorts after one year on treatment, possibly because the immune systems of
South African patients had sustained more HIV-induced damage, as evidenced by
lower CD4 T-cell counts, by the time patients started treatment.
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between 2 and 4 years on ART, mortality rates in North America were comparable
to or higher than those for South Africa. After statistical adjustment for
differences in baseline characteristics such as gender and stage of HIV
disease, the researchers estimated mortality rate ratios to be 0.46 (95% confidence
interval [CI] 0.37.58) comparing Europe to South Africa, and 1.62 (95% CI
1.27.05) comparing North America to South Africa between 24 and 48 months on
Substantial increase in attention
authors note that factors affecting survival on ART differ between settings:
"For example [hepatitis C] infection may impact later mortality in the
North America cohorts in this study," while in South Africa "those
accessing care may have been exceptionally motivated citizens, especially in
the early years of the programmes when treatment availability was more
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accompanying Perspective, Agnes Binagwaho of the Ministry of Health of Rwanda
and colleagues, who were not involved in the research, discuss the implications
of the study's results for people with HIV in both high- and low-income
countries. The Perspective authors point out that "disparities of access
and outcome that are both regional and intensely local in nature warrant a
substantial increase in attention in each of the settings studied."
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Image: Aids and HIV in cube from Shutterstock
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