title: Non-AIDS-defining events among HIV-1-infected adults receiving combination antiretroviral therapy in resource-replete versus resource-limited urban setting.
abstract: OBJECTIVE
  To compare incidence and distribution of non-AIDS-defining events (NADEs) among HIV-1-infected adults receiving combination antiretroviral therapy (cART) in urban sub-Saharan African versus United States settings.
  
  
  METHODS
  Retrospective cohort analysis of clinical trial and observational data.
  
  
  METHODS
  Compared crude and standardized (to US cohort by age and sex) NADE rates from two urban adult HIV-infected cART-initiating populations: a clinical trial cohort in Gaborone, Botswana (Botswana) and an observational cohort in Nashville, Tennessee (USA).
  
  
  RESULTS
  Crude NADE incidence rates were similar: 10.0 [95% confidence interval 6.3-15.9] per 1000 person-years in Botswana versus 12.4 [8.4-18.4] per 1000 person-years in the United States. However, after standardizing to an older, predominantly male US population, the overall NADE incidence rates were higher in Botswana [18.7 (8.3-33.1) per 1000 person-years]. Standardized rates differed most for cardiovascular events (8.4 versus 5.0 per 1000 person-years) and non-AIDS-defining malignancies (8.0 versus 0.5 per 1000 person-years) - both higher in Botswana. Conversely, hepatic NADE rates were higher in the United States (4.0 versus 0.0 per 1000 person-years), whereas renal NADE rates [3.0 per 1000 person-years (United States) versus 2.4 per 1000 person-years (Botswana)] were comparable.
  
  
  CONCLUSIONS
  Crude NADE incidence rates were similar between cART-treated patients in a US observational cohort and a sub-Saharan African clinical trial. However, when standardized to the US cohort, overall NADE rates were higher in Botswana. NADEs appear to be a significant problem in our sub-Saharan African setting, and the monitoring, prevention, and treatment of NADEs should be a critical component of care in resource-limited settings.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.forename: John R
authors.initials: JR
authors.lastname: Koethe
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Stinnette
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kipp
authors.forename: Hwanhee
authors.initials: H
authors.lastname: Hong
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.forename: Tendani
authors.initials: T
authors.lastname: Gaolathe
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Richard G
authors.initials: RG
authors.lastname: Marlink
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology*; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D014504:Urban Health; D019562:Viral Load; D014779:Virus Replication
chemical_list: D044966:Anti-Retroviral Agents