Browsing by Author "Koller M"

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Authors' Reply: Early Initiation of Antiretroviral Therapy Among Young Children: A Long Way to Go.
(2015-Oct-01) Koller M; Patel K; Chi BH; Wools-Kaloustian K; Dicko F; Chokephaibulkit K; Chimbetete C; Hazra R; Ayaya S; Leroy V; Trong HK; Egger M; Davies MA; *Institute of Social & Preventive Medicine (ISPM), University of Bern, Switzerland †Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN ‖Department of Pediatrics, Gabriel Toure Hospital, Bamako, Mali ¶Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand #Newlands Clinic, Harare, Zimbabwe **Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD ††Department of Pediatrics, College of Health Sciences, Moi University, Kenya ‡‡INSERM, French National Institute for Health and Medical Research, U897, Bordeaux, France §§Children's Hospital 1, Ho Chi Minh City, Vietnam ‖‖School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries.
(2015-Jan-01) Koller M; Patel K; Chi BH; Wools-Kaloustian K; Dicko F; Chokephaibulkit K; Chimbetete C; Avila D; Hazra R; Ayaya S; Leroy V; Truong HK; Egger M; Davies MA; *Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; †Department of Epidemiology, Harvard School of Public Health, Boston, MA; ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; ‖Department of Pediatrics, Gabriel Toure Hospital, Bamako, Mali; ¶Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; #Newlands Clinic, Harare, Zimbabwe; **Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD; ††Department of Pediatrics, College of Health Sciences, Moi University, Kenya; ‡‡INSERM, French National Institute for Health and Medical Research, U897, Bordeaux, France; §§Children's Hospital 1, Ho Chi Minh City, Vietnam; and ‖‖School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
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. METHODS: We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. RESULTS: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low- and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. CONCLUSIONS: Despite progress in most low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.
Implementation and Operational Research: Risk Charts to Guide Targeted HIV-1 Viral Load Monitoring of ART: Development and Validation in Patients From Resource-Limited Settings.
(2015-Nov-01) Koller M; Fatti G; Chi BH; Keiser O; Hoffmann CJ; Wood R; Prozesky H; Stinson K; Giddy J; Mutevedzi P; Fox MP; Law M; Boulle A; Egger M; *Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; †Kheth'Impilo, Cape Town, South Africa; ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; §Aurum Institute for Health Research, Johannesburg, South Africa; ‖Gugulethu ART Programme and Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa; ¶Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa; #Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa; **Sinikithemba Clinic, McCord Hospital, Durban, South Africa; ††Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; ‡‡Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa; §§Center for Global Health & Development and Department of Epidemiology, Boston University, Boston, MA; ‖‖Biostatistics and Databases Program, The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia; and ¶¶Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: HIV-1 RNA viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not available in many resource-limited settings. We developed and validated CD4-based risk charts to guide targeted VL testing. METHODS: We modeled the probability of virologic failure up to 5 years of ART based on current and baseline CD4 counts, developed decision rules for targeted VL testing of 10%, 20%, or 40% of patients in 7 cohorts of patients starting ART in South Africa, and plotted cutoffs for VL testing on colour-coded risk charts. We assessed the accuracy of risk chart-guided VL testing to detect virologic failure in validation cohorts from South Africa, Zambia, and the Asia-Pacific. RESULTS: In total, 31,450 adult patients were included in the derivation and 25,294 patients in the validation cohorts. Positive predictive values increased with the percentage of patients tested: from 79% (10% tested) to 98% (40% tested) in the South African cohort, from 64% to 93% in the Zambian cohort, and from 73% to 96% in the Asia-Pacific cohort. Corresponding increases in sensitivity were from 35% to 68% in South Africa, from 55% to 82% in Zambia, and from 37% to 71% in Asia-Pacific. The area under the receiver operating curve increased from 0.75 to 0.91 in South Africa, from 0.76 to 0.91 in Zambia, and from 0.77 to 0.92 in Asia-Pacific. CONCLUSIONS: CD4-based risk charts with optimal cutoffs for targeted VL testing maybe useful to monitor ART in settings where VL capacity is limited.