Recent Publications

Comparative durability of nevirapine versus efavirenz in first-line regimens during the first year of initiating antiretroviral therapy among Swaziland HIV-infected adults. Pan African Medical Journal

Abstract: Nevirapine (NVP) and Efavirenz (EFV) have generally comparable clinical and virologic efficacy. However, data comparing NVP durability to EFV are imprecise. We analyzed cohort data to compare durability of NVP to EFV among patients initiating ART in Mbabane, Swaziland. The primary outcome was poor regimen durability defined as any modification of NVP or EFV to the ART regimen. Multivariate Cox proportional hazards models were employed to estimate the risk of poor regimen durability 

Immune Recovery After Starting ART in HIV Infected Patients Presenting and Not Presenting With Tuberculosis in South Africa

Abstract: We studied the immune response after starting antiretroviral treatment (ART) in 15,646 HIV-infected patients with or without tuberculosis (TB) at presentation in 3 ART programs in South Africa between 2003 and 2010. Patients presenting with TB had similar increases in CD4 cells compared with all other patients (adjusted difference 4.9 cells/µL per 6 months, 95% confidence interval: 0.2 to 9.7). Younger age, advanced clinical stage, female sex, and lower CD4 cell count at ART start 

Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa

 Abstract:  Objective: HIV-positive pregnant women are at heightened risk of becoming lost to follow-up (LTFU) from HIV care. We examined LTFU before and after delivery among pregnant women newly-diagnosed with HIV. Methods: Observational cohort study of all pregnant women ≥18 years (N=300) testing HIV-positive for the first time at their first ANC visit between January–June 2010, at a primary healthcare clinic in Johannesburg, South Africa. Women (n=27) whose delivery date could not be 

Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies

Abstract: Background: Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults. Methods and Findings: Data were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV-positive adults starting ART for the first time. Estimates of mortality were obtained 

Cohort profile: the Themba Lethu Clinical Cohort, Johannesburg, South Africa

Abstract: The Themba Lethu Clinical Cohort was established in 2004 to allow large patient-level analyses from a single HIV treatment site to evaluate National Treatment Guidelines, answer questions of national and international policy relevance and to combine an economic and epidemiologic focus on HIV research. The current objectives of the Themba Lethu Clinical Cohort analyses are to: (i) provide cohort-level information on the outcomes of HIV treatment; (ii) evaluate aspects of HIV care and 

Ten years on ART – where to now?

Abstract: Next year marks the tenth anniversary since the rollout of antiretroviral therapy (ART) in South Africa (SA), the country with the largest number of people living with HIV in the world. SA also has the world’s largest antiretroviral therapy (ART) programme, with approximately 1.8 million people estimated to have received ART by mid-2011. The massive investments in treatment and prevention have been accompanied by great successes. Increasing ART coverage has led to a decline in 

Risk of Mortality and Loss to Follow-up amongst HIV-Positive Patients Prescribed Stavudine vs. Tenofovir: A matched cohort analysis

Abstract Background: In April 2010 the South African government replaced stavudine with tenofovir in first-line regimens available in the public sector despite tenofovir’s higher cost. This was done under the assumption that the change would improve treatment outcomes, partly through reduced toxicity and better adherence. We examined the risk of death and loss to follow-up in the first 12-months on antiretroviral therapy (ART) amongst HIV-positive patients initiated on tenofovir- versus 

Incidence and Risk Factors Associated with Tuberculosis in HIV-positive Children Receiving Antiretroviral Therapy in a Large South African Multicenter Cohort

Abstract Background: Tuberculosis (TB) in children is a direct consequence of adult TB and is a good marker of current trends in community transmission. We sought to estimate rates of, and risk factors for,  incident TB among HIV-infected children and adolescents receiving antiretroviral treatment (ART) in South Africa. Methods: We conducted a cohort analysis using prospectively collected data among HIV-infected children <18 years old who initiated ART between April 2004 and May 2011 at