Antiretroviral therapy for tuberculosis control in nine African countries

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dc.contributor.authorWilliams B.G.
dc.contributor.authorGranich R.
dc.contributor.authorDe Cock K.M.
dc.contributor.authorGlaziou P.
dc.contributor.authorSharma A.
dc.contributor.authorDyeb C.
dc.date.accessioned2011-05-15T16:02:18Z
dc.date.available2011-05-15T16:02:18Z
dc.date.issued2010
dc.description.abstractHIV has increased the incidence of tuberculosis (TB) by up to sevenfold in African countries, but antiretroviral therapy (ART) reduces the incidence of AIDS-related TB. We use a mathematical model to investigate the short-term and long-term impacts of ART on the incidence of TB, assuming that people are tested for HIV once a year, on average, and start ART at a fixed time after HIV seroconversion or at a fixed CD4+ cell count. We fit the model to trend data on HIV prevalence and TB incidence in nine countries in sub-Saharan Africa. If HIV-positive people start ART within 5 y of seroconversion, the incidence of AIDS-related TB in 2015 will be reduced by 48% (range: 37-55%). Long-term reductions depend sensitively on the delay to starting ART. If treatment is started 5, 2, or 1 y after HIV seroconversion, or as soon as people test positive, the incidence in 2050 will be reduced by 66% (range: 57-80%), 95% (range: 93-96%), 97.7% (range: 96.9-98.2%) and 98.4% (range: 97.8-98.9%), respectively. In the countries considered here, early ART could avert 0.71 ± 0.36 [95% confidence interval (CI)] million of 3.4 million cases of TB between 2010 and 2015 and 5.8 ± 2.9 (95% CI) million of 15 million cases between 2015 and 2050. As more countries provide ART at higher CD4+ cell counts, the impact on TB should be investigated to test the predictions of this model.
dc.description.versionConference Paper
dc.identifier.citationProceedings of the National Academy of Sciences of the United States of America
dc.identifier.citation107
dc.identifier.citation45
dc.identifier.issn278424
dc.identifier.other10.1073/pnas.1005660107
dc.identifier.urihttp://hdl.handle.net/10019.1/12410
dc.subjectcytokine
dc.subjectglucosylceramidase
dc.subjectanimal experiment
dc.subjectanimal model
dc.subjectcell damage
dc.subjectcell lineage
dc.subjectconference paper
dc.subjectcontrolled study
dc.subjectdendritic cell
dc.subjectGaucher disease
dc.subjectgene deletion
dc.subjecthematopoietic cell
dc.subjectimmunophenotyping
dc.subjectmacrophage
dc.subjectmesenchyme cell
dc.subjectmicroarray analysis
dc.subjectmouse
dc.subjectnonhuman
dc.subjectossification
dc.subjectosteoblast
dc.subjectosteopenia
dc.subjectosteoporosis
dc.subjectpriority journal
dc.subjectprotein deficiency
dc.subjectT lymphocyte
dc.subjectAcquired Immunodeficiency Syndrome
dc.subjectAfrica
dc.subjectAnti-Retroviral Agents
dc.subjectHIV Seropositivity
dc.subjectHumans
dc.subjectIncidence
dc.subjectModels, Statistical
dc.subjectTime Factors
dc.subjectTuberculosis
dc.titleAntiretroviral therapy for tuberculosis control in nine African countries
dc.typeConference Paper
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