We followed a cohort of 592 HIV-infected adults during 1292 person-years in Abidjan before the highly active antiretroviral therapy (HAART) era. On the basis of the exhaustive monitoring of nonantiretroviral drugs actually delivered to the patients and of the real cost of drugs at the cohort center's pharmacy during the study period, we estimated the mean cost of drugs per person per year (MCPPY) overall, by drug characteristics, and by patients' baseline CD4 cell count. The MCPPY was dollar 198 US overall and dolalr 83 US, dollar 101 US, dollar 186 US, dollar 233 US, and dollar 459 US in patients with a baseline CD4 count > or = 500 cells/mm, 350 to 499 cells/mm, 200 to 349 cells/mm, 100 to 199 cells/mm, and <100 cells/mm, respectively. The most costly classes of drugs were the antibacterial (MCPPY dollar 30 US), the antifungal (dollar 16 US), and the analgesic (dollar 6 US) classes in patients with a baseline CD4 count > or = 500 cells/mm versus the antifungal (dollar 208 US), the antibacterial (dollar 49 US), and the antiparasitic (dollar 31 US) classes in patients with a baseline CD4 count <100 cells/mm. These data could be used in further cost-effectiveness analyses that seek to prioritize health interventions. Meanwhile, they roughly suggest that successful antiretroviral treatment, which would stabilize the CD4 count above 500 cells/mm, could reduce by 5-fold the cost of nonantiretroviral drugs in HIV-infected adults in Abidjan.
Abstract Populations of the terrestrial garter snake ( Thamnophis elegans ) around Eagle Lake in California exhibit dramatic ecotypic differentiation in life history, colouration and morphology across distances as small as a few kilometres. We assayed the role of selection in ecotypic differentiation in T. elegans using F ST ‐ Q ST analysis and identified selective agents using direct and indirect observations. We extended the conventional implementation of the F ST ‐Q ST approach by using three‐level analyses of genetic and phenotypic variance to assess the role of selection in differentiating populations both within and between ecotypes. These results suggest that selection has driven differentiation between as well as within ecotypes, and in the presence of moderate to high gene flow. Our findings are discussed in the context of previous correlational selection analyses which revealed stabilizing and correlational selection for some of the traits examined.
Setting and patient characteristicsIn June 2004, Aconda, a nongovernmental organization created by researchers who had studied cohorts of HIV-infected adults and children in Abidjan, Côte d'Ivoire, between 1996 and 2003, 9,16 formed a partnership with the Institute of Public Health, Epidemiology and Development in Bordeaux, France, to study access to HIV care and treatment.The study was funded by the United States President's Emergency Plan for AIDS Relief through the Elizabeth Glaser Pediatric AIDS Foundation in Washington, DC, United States of America (USA).Details of the Aconda programme have been described elsewhere. 17Briefly, the Aconda team trained health workers in HIV care and implemented a standardized computer data management system which was controlled by a designated Une traduction en français de ce résumé figure à la fin de l'article.Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمةObjective To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIVinfected children in Côte d'Ivoire.Methods Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART.Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e.death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme.Findings The analysis included 3876 ART-naïve children.Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months).The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up, respectively.Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART.Independent predictors of 12-month mortality on ART were pre-ART weightfor-age z-score < -2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.Conclusion The large-scale programme to scale up paediatric ART in Côte d'Ivoire was effective.However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems.
Objective: To estimate the incidence and risk factors of mortality and severe morbidity during the first months following antiretroviral therapy (ART) initiation in West African adults. Methods: A cohort study in Abidjan in which 792 adults started ART with a median CD4 cell count of 252 cells/μl and were followed for a median of 8 months. Severe morbidity was defined as all World Health Organization stage 3 or 4-defining morbidity events other than oral candidiasis. Results: In patients with pre-ART CD4 cell count < 200, at 200–350 and > 350 cells/μl, incidence of mortality was 5.0 [95% confidence interval (CI), 2.6–8.7], 1.7 (95% CI, 0.6–3.8) and 0.0 (95% CI, 0.0–3.4]/100 person-years, and incidence of severe morbidity was 13.3 (95% CI, 9.0–19.1), 9.5 (95% CI, 6.2–12.9) and 7.9 (95% CI, 3.4–15.5)/100 person-years, respectively. The most frequent diseases were invasive bacterial diseases (32/65 episodes, 49%) and tuberculosis (25/65 episodes, 38%). Both diseases followed the same curve of decreasing incidence over time. Patients who experienced severe morbidity had higher risks of mortality, virological failure and immunological failure. Other independent risk factors for mortality and/or severe morbidity were: at baseline, high viral load, advanced clinical stage, past history of tuberculosis, low BMI, low haemoglobin and low CD4 cell count; during follow-up: low CD4 cell count and persistently detectable viral load. Conclusion: These data give new arguments to reinforce the hypothesis that, in this region, ART should be started before the CD4 cell count drops below 350 cells/μl. Further studies should assess whether patients with low BMI, low haemoglobin, high viral load or past history of tuberculosis should start ART earlier.
BackgroundStudies in developed countries have shown highly active antiretroviral therapy (HAART) decreases incidence of severe opportunistic diseases (ODs) in HIV-infected patients beyond that whic...
