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Non-AIDS-defining Events among HAART-treated Adults in an Urban US vs an Urban Sub-Saharan African Setting: 'high non-AIDS events rate in Africa'
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
William Wester*1,2,3, B Shepherd1, H Hong2, P Rebeiro1, H Bussmann2,3, S Stinnette1, T Gaolathe3, T Sterling1, C McGowan1, and R Marlink2,3
1Vanderbilt Univ Sch of Med, Nashville, TN, US; 2Harvard Sch of Publ Hlth, Boston, MA, US; and 3Botswana-Harvard Sch of Publ Hlth AIDS Initiative Partnership for HIV Res and Ed, Gaborone
ABSTRACT
Background: As highly active ART (HAART) has dramatically reduced the risk of AIDS-related opportunistic infections, non-AIDS related conditions such as renal, hepatic, cardiovascular (CV), and non-AIDS related malignancies have become major causes of morbidity and mortality among HAART-treated adults. Few studies have evaluated non-AIDS defining events (NADE) in sub-Saharan Africa (SSA), where the vast majority of HAART-treated adults reside.
Methods: We compared NADE rates from 2 different urban adult HIV-1 infected populations: an observational cohort (Comprehensive Care Center) in Nashville, TN (TN) vs a randomized clinical trial population (Adult ARV Treatment and Drug Resistance (Tshepo) study) in Gaborone, Botswana (BW). Both populations initiated HAART and were followed from 1 Jan 2003 to 31 Dec 2007. Characteristics presented as median with IQR for continuous variables and frequency and proportions for categorical variables.
Results: Baseline characteristics of entire cohort: median CD4+ was 243 (110 to 408) in TN vs 199 (136 to 252) in BW, with a median BMI of 24.5 [21.9 to 28.2] in TN vs 21.3 [19.2 to 24.3] in BW. There were 25 and 18 NADE in TN and BW, respectively. Among those with NADE, 88% were male in TN vs 44% in BW. Among NADE-related deaths in TN, 100% (3/3) were cirrhosis-related; of the 12 NADE-related deaths in BW, 8 (67%) were CV and 4 (33%) were due to non-AIDS malignancies (mostly lymphomas).
Conclusions: Overall NADE rates were comparable in these 2 settings. The higher rates of hepatic events in TN are most likely due to hepatitis C co-infection, which has not been seen in prior Botswana studies. There are higher rates of non-AIDS related malignancies in Sub-Saharan Africa; the reasons for this remain to be elucidated. CV associated mortality, especially among overweight adults, will continue to be a major cause of non-AIDS related morbidity and mortality in both settings. Longer-term NADE follow-up is needed. Presently, more effective treatments for hepatitis C and aggressive CV risk reduction strategies are clearly warranted.
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