Evidence map›Paper›PMID 25131801›Full record

ArticleJournal of the International AIDS Society2014

CD4 trajectory adjusting for dropout among HIV-positive patients receiving combination antiretroviral therapy in an East African HIV care centre.

Agnes N Kiragga, Judith J Lok, Beverly S Musick, Ronald J Bosch, Ann Mwangi, Kara K Wools-Kaloustian, Constantin T Yiannoutsos, East Africa IeDEA Regional Consortium

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the International AIDS Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 9 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 3 countries.

Agnes N KiraggaInfectious Diseases Institute, Kampala, Uganda.
Judith J LokDepartment of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
Beverly S MusickDepartment of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Ronald J BoschCenter for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA.
Ann MwangiSchool of Medicine, Moi University, Eldoret, Kenya.
Kara K Wools-KaloustianDivision of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.
Constantin T YiannoutsosDepartment of Biostatistics, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA; cyiannou@iupui.edu.
East Africa IeDEA Regional Consortium
Indiana University – Purdue University Indianapolis · USCancer Research And Biostatistics · USHarvard University · USIndiana University IndianapolisInfectious Diseases Institute · UGMoi University · KE

Funding

East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional ConsortiumU01AI069911 · NIAID · INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS · PI AGGREY SEMWENDERO SEMEERE, Kara Kay Wools-Kaloustian · 2006 to 2026
$57.7M
Quality Assurance and Quality Control Project Management: Improving Submissions and Study Conduct in the Human Subjects Research Prior Approval ProcessUL1TR002529 · NCATS · INDIANA UNIVERSITY INDIANAPOLIS · PI MOE, SHARON M, WIEHE, SARAH ELIZABETH · 2018 to 2022
$27.2M
Indiana Clinical and Translational Sciences InstituteUL1TR001108 · NCATS · INDIANA UNIVERSITY INDIANAPOLIS · PI DENNE, SCOTT C., SHEKHAR, ANANTHA · 2013 to 2017
$23.3M
Statistical Designs and Methods for Double-Sampling for HIV/AIDSR01AI102710 · NIAID · JOHNS HOPKINS UNIVERSITY · PI FRANGAKIS, CONSTANTINE E · 2013 to 2016
$1.6M
Methods to find and model predictors of the causal effect of HAARTR01AI100762 · NIAID · HARVARD SCHOOL OF PUBLIC HEALTH · PI LOK, JUDITH JACQUELINE · 2012 to 2015
$1.3M
NCATS NIH HHS UL1 TR001108NIAID NIH HHS R01 AI100762NIAID NIH HHS R01AI100762NIAID NIH HHS R01 AI102710NIAID NIH HHS U01 AI069911NIAID NIH HHS U01AI069911Wellcome Trust
6 · The paper itself

Abstract

objectiveEstimates of CD4 response to antiretroviral therapy (ART) obtained by averaging data from patients in care, overestimate population CD4 response and treatment program effectiveness because they do not consider data from patients who are deceased or not in care. We use mathematical methods to assess and adjust for this bias based on patient characteristics.

designWe examined data from 25,261 HIV-positive patients from the East Africa IeDEA Consortium.

methodsWe used inverse probability of censoring weighting (IPCW) to represent patients not in care by patients in care with similar characteristics. We address two questions: What would the median CD4 be "had everyone starting ART remained on observation?" and "were everyone starting ART maintained on treatment?"

resultsRoutine CD4 count estimates were higher than adjusted estimates even under the best-case scenario of maintaining all patients on treatment. Two years after starting ART, differences between estimates diverged from 30 cells/µL, assuming similar mortality and treatment access among dropouts as patients in care, to over 100 cells/µL assuming 20% lower survival and 50% lower treatment access among dropouts. When considering only patients in care, the proportion of patients with CD4 above 350 cells/µL was 50% adjusted to below 30% when accounting for patients not in care. One-year mortality diverged 6-14% from the naïve estimates depending on assumptions about access to care among lost patients.

conclusionsIgnoring mortality and loss to care results in over-estimation of ART response for patients starting treatment and exaggerates the efficacy of treatment programs administering it.

Indexed as

Patient DropoutsAdolescentAdultAfrica, EasternAnti-Retroviral AgentsCD4 Lymphocyte CountCD4-Positive T-LymphocytesFemaleHIV InfectionsHumansMaleModels, TheoreticalTreatment OutcomeYoung AdultAnti-Retroviral AgentsCD4 countHIV/AIDSIPCWMathematical modelingResource-limited settingsub-Saharan Africa

Identifiers

PMID25131801
PMCPMC4136415
OpenAlexW2106521319

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.