Evidence map›Paper›PMID 26951573›Full record

SynthesisClinical infectious diseases : an official publication of the Infectious Diseases Society of America2016

Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

Andrea Low, Georgios Gavriilidis, Natasha Larke, Marie-Renee B-Lajoie, Olivier Drouin, John Stover, Lulu Muhe, Philippa Easterbrook

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 95 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
95citing papers in PubMed, 7 pooled it
10.3field-weighted citation impact, top 1% 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

95 citing papers in PubMed, 7 syntheses or guidelines pooled it, 192 citations in OpenAlex.

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  6. Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews.European respiratory review : an official journal of the European Respiratory Society · 2019
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35 more citing papers are in PubMed but not listed here.

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 5 institutions in 4 countries.

Andrea LowClinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
Georgios GavriilidisHIV Department, World Health Organization, Geneva, Switzerland.
Natasha LarkeMedical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
Marie-Renee B-LajoieDepartment of Family Medicine.
Olivier DrouinDepartment of Pediatrics, McGill University, Montreal, Canada.
John StoverDepartment of Centerfor Modeling and Analysis, Avenir Health, Glastonbury, Connecticut.
Lulu MuheDepartment of Maternal, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland.
Philippa EasterbrookHIV Department, World Health Organization, Geneva, Switzerland.
World Health Organization · CHAvenir Health · USLondon School of Hygiene & Tropical Medicine · GBMcGill University · CAMedical Research Council · GB

Funding

Medical Research Council MR/K012126/1Wellcome TrustWellcome Trust WT087760/Z/08/ZWorld Health Organization 001
6 · The paper itself

Abstract

backgroundTo understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs).

methodsEligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/µL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case.

resultsWe identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95% CI, $43.8-$49.4 million).

conclusionsThere was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.

Indexed as

AIDS-Related Opportunistic InfectionsAnti-Retroviral AgentsDeveloping CountriesHIV InfectionsHumansIncidenceTuberculosisAnti-Retroviral Agentsantiretroviral therapyHIV-1low- and middle-income countriesopportunistic infectionstuberculosis

Identifiers

PMID26951573
PMCPMC4885646
OpenAlexW2300344391

What OpenQuestion holds

Textmetadata
LicenceCC BY
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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.