Evidence map›Paper›PMID 36008786›Full record

ArticleBMC infectious diseases2022

Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the "treat all" era: a retrospective cohort study from rural Rwanda.

Gentille Musengimana, Jean Paul Umugisha, Placide Habinshuti, Todd Anderson, Geraldine Mukesharurema, Eric Remera, Jean D'Amour Ndahimana, Dale A Barnhart

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

Article in BMC infectious diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
3.9field-weighted citation impact, top 5% 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

20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 39 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 2 institutions in 2 countries.

Gentille MusengimanaDivision of HIV/AIDs, Rwanda Biomedical Center, STIs and Viral Hepatitis, City of Kigali, Rwanda. gentiljolie@gmail.com.
Jean Paul UmugishaPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Placide HabinshutiPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Todd AndersonPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Geraldine MukesharuremaPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Eric RemeraDivision of HIV/AIDs, Rwanda Biomedical Center, STIs and Viral Hepatitis, City of Kigali, Rwanda.
Jean D'Amour NdahimanaPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Dale A BarnhartPartners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.
Rwanda Biomedical Center · RWHarvard Global Health Institute · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 2016 Rwanda adopted "treat all" where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists.

methodsWe conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm

resultsAmong 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months.

conclusionPresenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.

Indexed as

Anti-HIV AgentsHIV InfectionsCD4 Lymphocyte CountCohort StudiesFemaleHumansPregnancyRetrospective StudiesRwandaViral LoadAnti-HIV AgentsDelayed diagnosisHIVRwandaTest and treatTreat all

Identifiers

PMID36008786
PMCPMC9404671
OpenAlexW4293036565

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.