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http://ir.mu.ac.ke:8080/jspui/handle/123456789/6258
Title: | Benefits of enhanced infection prophylaxis at antiretroviral therapy initiation by cryptococcal antigen status |
Authors: | Petta, Sarah L Spyerb, Moira Haddowa, Lewis J Nhema, Ruth Benjamine, Laura A Najjukag, Grace Bilima, Sithembile Daudi, Ibrahim Musorod, Godfrey Kitabalwag, Juliet Selemani, George Kandiei, Salome Corneliusi, K Magut Katemba, Chrispus Berkley, Jay A Hassan, Amin S Kityog, Cissy Hakim, James Heyderman, Robert S Gibbb, Diana M Walker, Ann S |
Keywords: | Cryptococcus HIV Late presentation Prophylaxis |
Issue Date: | 25-Apr-2020 |
Publisher: | Wolter Klower |
Abstract: | Objectives: To assess baseline prevalence of cryptococcal antigen (CrAg) positivity; and its contribution to reductions in all-cause mortality, deaths from cryptococcus and unknown causes, and new cryptococcal disease in the REALITY trial. Design: Retrospective CrAg testing of baseline and week-4 plasma samples in all 1805 African adults/children with CD4þ cell count less than 100 cells/ml starting antiretrovi ral therapy who were randomized to receive 12-week enhanced-prophylaxis (flucona zole 100 mg/day, azithromycin, isoniazid, cotrimoxazole) vs. standard-prophylaxis (cotrimoxazole). Methods: Proportional hazards models were used to estimate the relative impact of enhanced-prophylaxis vs. standard-cotrimoxazole on all, cryptococcal and unknown deaths, and new cryptococcal disease, through 24 weeks, by baseline CrAg positivity. Results: Excluding 24 (1.4%) participants with active/prior cryptococcal disease at enrolment (all treated for cryptococcal disease), 133/1781 (7.5%) participants were CrAg-positive. By 24 weeks, 105 standard-cotrimoxazole vs. 78 enhanced-prophylaxis participants died. Of nine standard-cotrimoxazole and three enhanced-prophylaxis cryptococcal deaths, seven and two, respectively, were CrAg-positive at baseline. Among deaths of unknown cause, only 1/46 standard-cotrimoxazole and 1/28 enhanced-prophylaxis were CrAg-positive at baseline. There was no evidence that relative reductions in new cryptococcal disease associated with enhanced-prophylaxis varied between baseline CrAg-positives [hazard-ratio ¼ 0.36 (95% confidence interval 0.13–0.98), incidence 19.5 vs. 56.5/100 person-years] and CrAg-negatives [hazard ratio ¼ 0.33 (0.03–3.14), incidence 0.3 vs. 0.9/100 person-years; Pheterogeneity¼ 0.95]; nor for all deaths, cryptococcal deaths or unknown deaths. |
URI: | http://ir.mu.ac.ke:8080/jspui/handle/123456789/6258 |
Appears in Collections: | School of Medicine |
Files in This Item:
File | Description | Size | Format | |
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MAGUT 2.pdf | 357.94 kB | Adobe PDF | View/Open |
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