Recent Publications

Decrease in Single Drug Substitutions in the First 12-months on First-line Treatment amongst HIV-positive Patients in Johannesburg, South Africa

Abstract Background: Although tenofovir and stavudine have performed equally well with respect to viral suppression, tenofovir has been associated with less toxicity than stavudine. We investigated whether single-drug substitutions have decreased with the introduction of tenofovir into standard first-line therapy in South Africa in 2010. Methods: Prospective cohort analysis examining the yearly trend in single-drug substitutions from April 2004-June 2011 at the Themba Lethu Clinic in 

The early effects of stavudine compared with tenofovir on adipocyte gene expression, mitochondrial DNA copy number and metabolic parameters in South African HIV-infected patients: a randomized trial

Abstract: Objectives: Stavudine is being phased out because of its mitochondrial toxicity and tenofovir (TDF) is recommended as part of first-line highly active antiretroviral therapy (HAART) in South Africa. A prospective, open-label, randomized controlled trial comparing standard- and low-dose stavudine with TDF was performed to assess early differences in adipocyte mtDNA copy number, gene expression and metabolic parameters in Black South African HIV-infected patients. Methods: Sixty 

Incident Pregnancy and Time to Death or AIDS among HIV-Positive Women Receiving Antiretroviral Therapy

Abstract: Background: Little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in sub-Saharan Africa. We examined the effect of incident pregnancy after HAART initiation on clinical response to HAART. Methods: We evaluated a prospective clinical cohort of adult women initiating HAART in Johannesburg, South Africa between 1 April 2004 and 31 March 2011, and followed up until an event, transfer, drop-out, or administrative end of followup on 30 

Incidence of Herpes Zoster among HIV-infected Patients on Antiretroviral Therapy in Johannesburg, South Africa – Who Should We Vaccinate?

Abstract Background: Herpes zoster, caused by the varicella zoster virus, is a predominantly dermatologic condition which results in a painful rash in those infected. Commonly seen in the elderly, it can also present as an opportunistic infection associated with HIV infection. Zoster diagnosed early in treatment combined with an increase in CD4 count may be attributed to immune reconstitution inflammatory syndrome (IRIS). Methods: We included all antiretroviral therapy (ART)-naïve patients, 

A Decline in Community Viral Load in Cape Town and Johannesburg, South Africa between 2004 to 2011

Abstract Background: The total number of people living with HIV in South Africa in 2011 is estimated at approximately 5.4 million, with a prevalence of 16.6% in the adult antenatal population: ranging from 6.2% in the Western Cape to 16.6% in Gauteng provinces, respectively. Antiretroviral therapy (ART) became accessible in 2004, with an estimated 1.4 million on treatment by December 2011. Prior work has suggested that a community viral load (CVL) can be used as a tool for monitoringthe 

Viremia Copy-years as a Measure of Viral Load Burden and Associated Mortality Risk among Antiretroviral Therapy Patients in Johannesburg, South Africa

Abstract Background: A detectable HIV viral load after antiretroviral therapy (ART) initiation is associated with poor outcomes; however simple measures of detectable viremia may miss the cumulative effects of exposure to circulating virus over time. Viremia copy-years has been demonstrated to have prognostic value for mortality in resource-rich cohorts. We evaluated the relationship between viremia copy-years and mortality versus dichotomous measures of viremia amongst patients on ART in 

Attrition through Multiple Stages of HIV Care in South Africa: A Challenge for Test-and-Treat

Abstract Introduction: While momentum for test-and-treat strategies has been increasing in resource limited settings, if patients cannot be retained in HIV care continuously from the time of testing positive through long term adherence to antiretroviral therapy (ART), such strategies may fall well short of the expected gains. While numerous estimates of retention on ART exist, few cohorts have data on retention from testing positive through pre-ART and on ART care. Methods: We explored 

The Effect of 30 vs. 40mg of Stavudine vs. Tenofovir on Treatment Outcomes amongst HIV-positive Patients in Johannesburg, South Africa

Abstract Background: In 2007 the WHO recommended reducing stavudine (d4T) dosage from 40 to 30mg for all HIV-positive adults on antiretroviral therapy (ART) and in 2009 recommended discontinuing d4T for initial HIV treatment due to side effects. Although many resource-limited countries have changed treatment guidelines to substitute tenofovir (TDF) for d4T, in others, d4T is still used. Therefore, determining the effect on treatment outcomes, specifically single-drug substitutions, of reduced 

Point-of-care Xpert® MTB/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa

Abstract: Objective: To assess the clinical utility and cost of point-of-care Xpert® MTB/RIF for the diagnosis of smear-negative tuberculosis (TB). Design: Cohort study of smear-negative TB suspects at a South African primary care clinic. Participants provided one sputum sample for fluorescent smear microscopy and culture and an additional sample for Xpert. Outcomes of interest were TB diagnosis, linkage to care, patient and provider costs. Results: Among 199 smear-negative TB suspects, 16 

The Feasibility of Using Screening Criteria to Reduce Clinic Visits for Stable Patients on Antiretroviral Therapy in South Africa

Abstract: Objectives: South African HIV care providers are exploring ways to reduce the intensity of patient visits while maintaining high quality of care. We used routinely collected data to model whether a simple screening tool could identify stable patients who would not need to see a doctor during a scheduled medical visit. Design:We identified stable and nonstable visits from January 2007 to September 2011 at a large HIV clinic in Johannesburg, SA. Stable medical visits were defined as 

Rates and Cost of Hospitalization Before and After Initiation of Antiretroviral Therapy in Urban and Rural Settings in South Africa

Abstract: Few studies have compared hospitalizations before and after antiretroviral therapy (ART) initiation in the same patients. We analyzed the cost of hospitalizations among 3906 adult patients in 2 South African hospitals, 30% of whom initiated ART. Hospitalizations were 50% and 40% more frequent and 1.5 and 2.6 times more costly at a CD4 cell count, 100 cells/mm(3) when compared with 200–350 cells/mm(3) in the pre-ART and ART period, respectively. Mean inpatient cost per patient 

Patient Retention From HIV Diagnosis Through One Year on Antiretroviral Therapy at a Primary Health Care Clinic in Johannesburg, South Africa

Abstract: Objective: To compare patient retention at three stages of pre-antiretroviral (ART) care and two stages of post-ART care to identify when greatest attrition occurs. Design: An observational cohort study. Methods: We reviewed files of all adult, non-pregnant individuals testing HIV-positive January 1 – June 30, 2010, at a primary health clinic in Johannesburg, South Africa (N=842). We classified retention in pre-ART stage 1 (HIV diagnosis to CD4 results notification in ≤3 months),