Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. MethodsAnalyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL ( ! 3, 1-2 or o1) or CD4 ( ! 3 or o3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (o400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. ResultsIncreased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR) 5 1.4; P 5 0.032], severely symptomatic HIV infection (HR 5 1.4; P 5 0.003) and hepatitis C virus coinfection (HR 5 1.8; P 5 0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (Po0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P 5 0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR) [1,2]. Disparities remain in patient access to antiretrovirals (ARVs), however, the challenges of treatment coverage and health system capacity are being progressively addressed [3]. As a result, more HIV-infected patients in developing and transitional economies have the opportunities of decreased morbidity and longer survival as have been observed in developed economies [4][5][6]. Predictive biomarkers of disease progression are HIV RNA in plasma (VL) and CD4 cell count (immune function) [7]. HIV RNA informs knowledge of trends in viral replication and gives advance notice of non-adherence, treatment regimen failure and HIV drug resistance (HIVDR) [8,9]. CD4 cell counts provide quantitative measures of immunocompetence and current clinical status [10]. Furthermore, international patient management guidelines recommend periodic collection of HIV RNA and CD4 cell counts to determine indications for treatment and the monitoring of therapeutic response [11,12].Still, in developing countries access to disease staging diagnostics has lagged considerably behind the availability of anti-HIV medications [13]. Consequently, monitoring of patient status via surrogate markers, thereby identifying optimal therapy initiation periods and when treatment should be changed, is not available in resource-limited settings at a level comp...

Setting Tuberculosis (TB) is the most common HIV-related opportunistic infection and AIDS-related death. TB often affects those from low socio-economic background. Objective This matched case-control study was designed to assess socio-economic determinants of TB in HIV-infected patients in Asia. Design HIV-positive-TB-positive cases were matched to HIV-positive-TB-negative controls according to age, sex and CD4 cell count. A socio-economic questionnaire consisting of 23 questions including education level, employment, housing and substance use, was distributed. Socio-economic risk factors for TB was analysed using conditional logistic regression analysis. Results A total of 340 patients (170 matched pairs) were recruited, with 262 (77.1%) matched on all three criteria. Pulmonary TB was the predominant type (115, 67.6%). The main risk factor for TB was not having university level education (OR=4.45, 95%CI (1.50-13.17), p=0.007). Burning wood or coal regularly inside the house and living in the same place of origin were weakly associated with TB diagnosis. Conclusions Our data suggests that lower socio-economic status is associated with increased risk of TB in Asia. Integrating clinical and socio-economic factors into the treatment of HIV may help in the prevention of opportunistic infections and disease progression.

Objectives Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource‐limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia‐Pacific. Methods PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow‐up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow‐up as a competing risk. Results A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first‐year mortality rate was 4.27 per 100 person‐years (PY). Thirty‐eight deaths (52%) were AIDS‐related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)‐related, 13 (18%) were non‐AIDS‐related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub‐hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60–5.32] compared to BMI 18.5–24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62–23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05–0.26) was associated with reduced hazard for mortality compared to CD4 count ≤ 25 cells/μL. Conclusions Fifty‐two per cent of early deaths were AIDS‐related. Efforts to initiate ART at CD4 counts > 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.

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