eprintid: 1373451
rev_number: 55
eprint_status: archive
userid: 608
dir: disk0/01/37/34/51
datestamp: 2012-11-29 15:28:05
lastmod: 2021-12-05 01:09:48
status_changed: 2015-11-02 14:24:57
type: article
metadata_visibility: show
item_issues_count: 0
creators_name: Ford, DJ
creators_name: Robins, J
creators_name: Petersen, M
creators_name: Gibb, DM
creators_name: Gilks, CF
creators_name: Mugyenyi, P
creators_name: Grosskurth, H
creators_name: Hakim, J
creators_name: Katabira, E
creators_name: Babiker, AG
creators_name: Walker, AS
title: The impact of different CD4 monitoring and switching strategies on mortality in HIV-infected African adults on antiretroviral therapy; an application of dynamic marginal structural models
ispublished: pub
divisions: UCL
divisions: B02
divisions: D65
divisions: J38
note: © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
abstract: In Africa, antiretroviral therapy (ART) is delivered with limited laboratory monitoring, often none. In 2003–2004, investigators in the Development of Antiretroviral Therapy in Africa (DART) Trial randomized persons initiating ART in Uganda and Zimbabwe to either laboratory and clinical monitoring (LCM) or clinically driven monitoring (CDM). CD4 cell counts were measured every 12 weeks in both groups but were only returned to treating clinicians for management in the LCM group. Follow-up continued through 2008. In observational analyses, dynamic marginal structural models on pooled randomized groups were used to estimate survival under different monitoring-frequency and clinical/immunological switching strategies. Assumptions included no direct effect of randomized group on mortality or confounders and no unmeasured confounders which influenced treatment switch and mortality or treatment switch and time-dependent covariates. After 48 weeks of first-line ART, 2,946 individuals contributed 11,351 person-years of follow-up, 625 switches, and 179 deaths. The estimated survival probability after a further 240 weeks for post-48-week switch at the first CD4 cell count less than 100 cells/mm3 or non-Candida World Health Organization stage 4 event (with CD4 count <250) was 0.96 (95% confidence interval (CI): 0.94, 0.97) with 12-weekly CD4 testing, 0.96 (95% CI: 0.95, 0.97) with 24-weekly CD4 testing, 0.95 (95% CI: 0.93, 0.96) with a single CD4 test at 48 weeks (baseline), and 0.92 (95% CI: 0.91, 0.94) with no CD4 testing. Comparing randomized groups by 48-week CD4 count, the mortality risk associated with CDM versus LCM was greater in persons with CD4 counts of <100 (hazard ratio = 2.4, 95% CI: 1.3, 4.3) than in those with CD4 counts of ≥100 (hazard ratio = 1.1, 95% CI: 0.8, 1.7; interaction P = 0.04). These findings support a benefit from identifying patients immunologically failing first-line ART at 48 weeks.
date: 2015-08-26
official_url: http://dx.doi.org/10.1093/aje/kwv083
oa_status: green
full_text_type: pub
language: eng
article_type_text: Article
verified: verified_manual
elements_source: Manually entered
elements_id: 830253
doi: 10.1093/aje/kwv083
publication_declined: 2015-04-16T21:03:05BST
lyricists_name: Babiker, Abdel
lyricists_name: Ford, Deborah
lyricists_name: Gibb, Diana
lyricists_name: Walker, Ann
lyricists_id: ABABI41
lyricists_id: DFORD95
lyricists_id: MGIBB48
lyricists_id: ASWAL40
full_text_status: public
publication: American Journal of Epidemiology
volume: 182
number: 7
citation:        Ford, DJ;    Robins, J;    Petersen, M;    Gibb, DM;    Gilks, CF;    Mugyenyi, P;    Grosskurth, H;                 ... Walker, AS; + view all <#>        Ford, DJ;  Robins, J;  Petersen, M;  Gibb, DM;  Gilks, CF;  Mugyenyi, P;  Grosskurth, H;  Hakim, J;  Katabira, E;  Babiker, AG;  Walker, AS;   - view fewer <#>    (2015)    The impact of different CD4 monitoring and switching strategies on mortality in HIV-infected African adults on antiretroviral therapy; an application of dynamic marginal structural models.                   American Journal of Epidemiology , 182  (7)      10.1093/aje/kwv083 <https://doi.org/10.1093/aje%2Fkwv083>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1373451/4/The%20Impact%20of%20Different%20CD4%20Cell-Count%20Monitoring%20and%20Switching%20Strategies%20on%20Mortality%20in%20HIV-Infected%20African%20Adults%20on%20Antiretroviral%20Therapy%3A%20An%20Application%20of%20Dynamic%20Marginal%20Structural%20Models..pdf