Browsing by Author "Sloot, R."

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    Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa
    (Wiley, 2019) Bock, P.; Nel, K.; Fatti, G.; Sloot, R.; Ford, N.; Voget, J.; Gunst, C.; Grobbelaar, N.; Louis, F.; Floyd, S.; Hayes, R.; Ayles, H.; Beyers, N.; Fidler, S.
    Objectives: Renal dysfunction is a significant cause of morbidity and mortality among HIV-positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods: A retrospective cohort analysis of routine data for HIV-positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) < 60 mL/min after ART initiation among individuals with a baseline (pre-ART) eGFR ≥ 60 mL/min. Results: Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195–468 cells/μL], were included in the analysis. Forty-seven individuals had a baseline eGFR < 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir-containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR < 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR < 60 mL/min at baseline CD4 counts of > 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11–0.80], 351–500 cells/μL (aOR 0.22; 95% CI 0.08–0.59) and 201–350 (aOR 0.48; 95% CI: 0.24–0.97) compared with baseline CD4 counts < 200 cells/μL. Conclusions: This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts > 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.
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    Variation in HIV prevalence and the population-level effects of antiretroviral therapy in reducing tuberculosis incidence in South Africa
    (Health & Medical Publishing Group, 2018) Sloot, R.; Maarman, G. J.; Osman, M.; Marx, F. M.
    The current year (2018) marks the 10th year after the tuberculosis (TB) epidemic in South Africa (SA) reached a historic peak of 848 incident TB cases per 100 000 population in 2008.[1,2] TB incidence has since decreased at an average of 2.0% annually to 781 per 100 000 in 2016.[1,2] The decline observed in the past decade has mainly been attributed to the expansion of HIV testing and antiretroviral therapy (ART).[1,2] Despite these and other public health efforts, TB remains a leading cause of death in SA,[1] and at the current rate of decline, SA will not reach the 2035 targets of the End TB Strategy.