Recent Publications

Effectiveness and safety of 30mg versus 40mg stavudine regimens: a cohort study among HIV-infected adults initiating HAART in South Africa

Abstract: Background: As stavudine remains an important and widely prescribed drug in resource-limited settings, the effect of a reduced dose of stavudine (from 40 mg to 30 mg) on outcomes of highly active antiretroviral therapy (HAART) remains an important public health question. Methods: We analyzed prospectively collected data from the Themba Lethu Clinic in Johannesburg, South Africa. We assessed the relationship between stavudine dose and six- and/or 12-month outcomes of stavudine 

The Feasibility of Using Criteria to Identify Stable Patients on HAART at Themba Lethu Clinic

Abstract Background: With recent increases in eligibility criteria to a CD4 count <350, South Africa has begun to see rapid growth in the number of patients on highly-active antiretroviral therapy (ART). The expanding number of patients is creating a substantial burden on HIV treatment staff and contributing to long waiting times for patients. HIV clinics are exploring ways to reduce the overall number of visits patients need to reduce the burden on staff. We sought to use routinely 

HIV-related Burden on South African Hospitals in the Era of Large-scale Access to Antiretroviral Therapy

Abstract Background: Prior to the large scale roll out of antiretroviral therapy (ART) for HIV in South Africa (RSA), HIV-related conditions were estimated to be responsible for at least half of all inpatient admissions to medical wards of public hospitals. Since 2004, RSA has actively expanded its HIV treatment program and in 2009 had an estimated ART coverage of 56% under the WHO 2006 guidelines. Currently it has 1.4 million patients on ART. We analyzed inpatient records at a large, urban, 

Short-term impacts of a change in ART initiation threshold for patients co-infected with TB in Johannesburg, South Africa

Abstract Introduction: Recent studies showed earlier antiretroviral therapy (ART) initiation in patients co-infected with tuberculosis (TB) leads to reduced mortality. On April 1st, 2010 South Africa changed its HIV treatment guidelines to initiate patients with TB at CD4 counts <350 cells/mm3, up from <200 cells/mm3.  We evaluated short-term impacts of the guideline change by comparing treatment outcomes for co-infected patients before and after the policy change at the Themba 

What to do with Xpert negatives? The cost of alternative diagnostic algorithms for TB suspects who are Xpert MTB negative in a high HIV/MDR-TB burden setting

Abstract Background: South Africa is rapidly implementing the World Health Organization’s recommendation to adopt Xpert MTB/RIF technology (Xpert) for first-line diagnosis of pulmonary tuberculosis (TB). With a high burden of HIV/TB co-infection and a high proportion of patients with smear-negative TB, however, determining a diagnostic algorithm for Xpert negative TB suspects remains important. South Africa’s current Xpert algorithm calls for HIV-infected TB suspects with an initial 

Increased risk of mortality and loss to follow-up among HIVpositive patients with oropharyngeal candidiasis and malnutrition before antiretroviral therapy initiation: a retrospective analysis from a large urban cohort in Johannesburg, South Africa

Abstract: Objective: We investigated the effect of oropharyngeal candidiasis (OC) and body mass index (BMI) before antiretroviral therapy (ART) initiation on treatment outcomes of human immunodeficiency virus (HIV)–positive patients. Study Design: Treatment outcomes included failure to increase CD4 count by 50 or 100 cells/L or failure to suppress viral load (400 copies/mL) at 6 or 12 months in addition to loss to follow-up (LTFU) and mortality by 12 months. Risk and hazard ratios (HRs) were