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Effectiveness of Highly Active Antiretroviral Therapy in HIV patients in resource-limited settings

Tuboi, Suely Hiromi (2008) Effectiveness of Highly Active Antiretroviral Therapy in HIV patients in resource-limited settings. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tuboi, Suely
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHarrison, Lee Hlharriso@edc.pitt.eduLHARRISO
Committee MemberMcMahon, Deborahmcmahon@msx.dept-med.pitt.eduMCMAHOND
Committee MemberKingsley, Lawrencekingsley@pitt.eduKINGSLEY
Committee MemberYee, Lelandyeel@edc.pitt.eduLJY5
Committee MemberStone, Roslyn Aroslyn@pitt.eduROSLYN
Date: 23 June 2008
Date Type: Completion
Defense Date: 1 February 2008
Approval Date: 23 June 2008
Submission Date: 14 April 2008
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: effectiveness; HAART; immunologic; low-income countries; HIV; virologic
Other ID:, etd-04142008-074019
Date Deposited: 10 Nov 2011 19:37
Last Modified: 19 Dec 2016 14:35


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