Advanced Human Immunodeficiency Virus Disease in Botswana Following Successful Antiretroviral Therapy Rollout: Incidence of and Temporal Trends in Cryptococcal Meningitis

Autor: Raju K. K. Patel, Hunter H. Stone, Ephraim Tawanana, Tlhagiso Pilatwe, Chandapiwa Ramodimoosi, Paul C. Mullan, Mooketsi Molefi, Elizabeth A. Williams, Andrew P. Steenhoff, Nametso Lekwape, Hannah K Mitchell, Mark W Tenforde, Kelebeletse O Mokobela, Bonno Dube, Madisa Mine, Doreen L Banda, Yohana Mashalla, Joseph N Jarvis, Tshepo B Leeme, Heston Phillips, William J Hurt, Margaret Mokomane, Kabelo Mokgacha
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
Pediatrics
medicine.medical_specialty
Adolescent
Referral
030106 microbiology
Population
Human immunodeficiency virus (HIV)
HIV Infections
Meningitis
Cryptococcal
medicine.disease_cause
Young Adult
03 medical and health sciences
0302 clinical medicine
Pharmacotherapy
medicine
Humans
030212 general & internal medicine
Child
education
Articles and Commentaries
Aged
Retrospective Studies
Aged
80 and over
education.field_of_study
Botswana
AIDS-Related Opportunistic Infections
business.industry
Incidence
Incidence (epidemiology)
Infant
Newborn
virus diseases
Infant
Middle Aged
medicine.disease
Antiretroviral therapy
3. Good health
Infectious Diseases
Anti-Retroviral Agents
Child
Preschool
Immunology
Female
Cryptococcal meningitis
business
Meningitis
ISSN: 1058-4838
Popis: Background: Botswana has a well-developed antiretroviral therapy (ART) program that serves as a regional model. With wide ART availability, the burden of advanced human immunodeficiency virus (HIV) and associated opportunistic infections would be expected to decline. We performed a nationwide surveillance study to determine the national incidence of cryptococcal meningitis (CM), and describe characteristics of cases during 2000-2014 and temporal trends at 2 national referral hospitals. Methods: Cerebrospinal fluid data from all 37 laboratories performing meningitis diagnostics in Botswana were collected from the period 2000-2014 to identify cases of CM. Basic demographic and laboratory data were recorded. Complete national data from 2013-2014 were used to calculate national incidence using UNAIDS population estimates. Temporal trends in cases were derived from national referral centers in the period 2004-2014. Results: A total of 5296 episodes of CM were observed in 4702 individuals; 60.6% were male, and median age was 36 years. Overall 2013-2014 incidence was 17.8 (95% confidence interval [CI], 16.6-19.2) cases per 100000 person-years. In the HIV-infected population, incidence was 96.8 (95% CI, 90.0-104.0) cases per 100000 person-years; male predominance was seen across CD4 strata. At national referral hospitals, cases decreased during 2007-2009 but stabilized during 2010-2014. Conclusions: Despite excellent ART coverage in Botswana, there is still a substantial burden of advanced HIV, with 2013-2014 incidence of CM comparable to pre-ART era rates in South Africa. Our findings suggest that a key population of individuals, often men, is developing advanced disease and associated opportunistic infections due to a failure to effectively engage in care, highlighting the need for differentiated care models.
Databáze: OpenAIRE
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