The HIV pandemic has posed an unprecedented challenge to the global health, devastating communities and reinforcing the historical problems that link ill-health with poverty. Sound evidence for public health decision-making is needed as antiretroviral programmes are being rolled out in developing countries. This thesis discusses the effectiveness of Highly Active Antiretroviral Therapy (HAART) in resource-limited countries from the Antiretroviral Therapy in Lower Income Countries (ART-LINC), a network of HIV/AIDS treatment programmes and cohorts in Africa, South America, and Asia. The objectives of this project were to document the effectiveness of HAART in these settings, defined by changes in immunologic and virologic markers within 6 months of treatment; assess factors associated with 6-month response to therapy; and to assess the association of 6 month response with long-term outcomes.
In the first article, the evidence supporting effectiveness of HAART is reviewed, focusing on aspects of immunologic and virologic responses to therapy. Despite the lack of a standardized definition of immunologic and virologic response, we conclude that around one third of the patients who start HAART show a response pattern where either immunologic or virologic response is not achieved, a condition referred to as discordant response.
The second and third articles provide a picture of the association between HAART and 6-month response in resource-limited countries. Overall, the effectiveness of HAART in these settings is similar to that reported in resource-rich countries. Finally, we assessed the association between immunologic and virologic discordant responses at 6 months and mortality in ART-LINC. We found that the hazard of death for those showing discordance at 6 months was similar to that reported in resource-rich countries. However, we found that early mortality was high in Africa and Asia, and a significant proportion of patients that did not have access to laboratory measurements were also at greater risk of death. This is the first report on the association of discordant responses and mortality in lower income countries, which provides important evidence for public health decision making in the context of antiretroviral rollout.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04142008-074019 |
| Date | 23 June 2008 |
| Creators | Tuboi, Suely Hiromi |
| Contributors | Deborah McMahon, Lee H. Harrison, Lawrence Kingsley, Leland Yee, Roslyn A. Stone |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04142008-074019/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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