Incidence of Opportunistic Infections and the impact of Antiretroviral Therapy among HIV-Infected Adults in Low and Middle Income Countries: a Systematic Review and Meta-analysis.


Low, A; Gavriilidis, G; Larke, N; Lajoie, MR; Drouin, O; Stover, J; Muhe, L; Easterbrook, P; (2016) Incidence of Opportunistic Infections and the impact of Antiretroviral Therapy among HIV-Infected Adults in Low and Middle Income Countries: a Systematic Review and Meta-analysis. Clinical infectious diseases. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/ciw125

[img]
Preview
Text - Published Version
License:

Download (469kB) | Preview

Abstract

To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in HIV-infected adults in low and middle-income countries (LMIC).  Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naïve period, and during and after the first year of ART, were calculated using random effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at CD4 ≥200 cells/μl was estimated using UNAIDS country estimates and global average OI treatment cost per case.  We identified 7,965 citations, and included 126 studies describing 491,608 HIV-infected persons. In ART-naïve patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range 57-91%) except for tuberculosis, and was largest for oral candidiasis, PCP and toxoplasmosis. Earlier ART was estimated to have averted 857,828 cases in 2013 (95% confidence interval [CI], 828,032-874,853), with cost savings of $46.7 million (95% CI, 43.8-49.4).  There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 26951573
Web of Science ID: 378434900021
URI: http://researchonline.lshtm.ac.uk/id/eprint/2537239

Statistics


Download activity - last 12 months
Downloads since deposit
47Downloads
67Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item