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HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town

Overview of attention for article published in BMC Infectious Diseases, July 2018
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Title
HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town
Published in
BMC Infectious Diseases, July 2018
DOI 10.1186/s12879-018-3256-9
Pubmed ID
Authors

Richard Kaplan, Sabine Hermans, Judy Caldwell, Karen Jennings, Linda-Gail Bekker, Robin Wood

Abstract

In Cape Town, the roll-out of antiretroviral therapy (ART) has increased over the last decade with an estimated coverage of 63% of HIV- positive patients in 2013. The influence of ART on the characteristics of the population of HIV-positive patients presenting to the primary care TB programme is unknown. In this study, we examined trends in CD4 count distribution, ART usage and treatment outcomes among HIV-positive TB patients in Cape Town from 2009 to 2013. Data from the electronic TB register on all newly registered drug-sensitive TB patients ≥18 years were analyzed retrospectively. Descriptive statistics were used to compare baseline characteristics, the CD4 count distribution and TB treatment outcomes both by year of treatment and ART status at the start of TB treatment. Survival analyses were used to assess the change in mortality risk during TB treatment over time, stratified by ART status at start of TB treatment. 118,989 patients were treated over 5 years. HIV prevalence among TB patients decreased from 50.9% in 2009 to 49.0% in 2013. The absolute number of HIV-positive TB cases declined by 13.2% between 2010 and 2013. More patients entered the TB programme on ART in 2013 compared to 2009 (30.0% vs 9.9%). Among these, the CD4 count distribution showed a year by year shift to higher CD4 counts. In 2013, over 75% of ART-naïve TB patients still had a CD4 count < 350 cells/mm3. ART initiation among ART-naive patients increased from 37.0 to 77.7% and TB case fatality declined from 7.4 to 5.2% (p < 0.001). In multivariate analysis a decrease in TB mortality was most strongly associated with CD4 count (Adjusted HR 0.82 per increase of 50 cells/mm3, 95% CI: 0.81-0.83, p < 001) and the initiation of ART during TB treatment (Adjusted HR 0.39, 95% CI: 0.35-0.42, p < 0.001). Comprehensive changes in the ART and TB treatment programmes resulted in incremental increases in ART coverage for HIV-positive TB patients and a subsequent decrease in TB case fatality due to increased ART uptake in HIV-positive ART-naïve patients. However TB still remained a major presenting opportunistic infection with the majority of cases occurring at low CD4 counts.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 107 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 107 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 17 16%
Student > Ph. D. Student 12 11%
Researcher 11 10%
Student > Postgraduate 6 6%
Student > Bachelor 6 6%
Other 18 17%
Unknown 37 35%
Readers by discipline Count As %
Medicine and Dentistry 31 29%
Nursing and Health Professions 9 8%
Social Sciences 6 6%
Biochemistry, Genetics and Molecular Biology 4 4%
Immunology and Microbiology 4 4%
Other 11 10%
Unknown 42 39%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 July 2019.
All research outputs
#18,646,262
of 23,099,576 outputs
Outputs from BMC Infectious Diseases
#5,673
of 7,751 outputs
Outputs of similar age
#253,586
of 329,833 outputs
Outputs of similar age from BMC Infectious Diseases
#115
of 163 outputs
Altmetric has tracked 23,099,576 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 7,751 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.3. This one is in the 15th percentile – i.e., 15% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 329,833 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 12th percentile – i.e., 12% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 163 others from the same source and published within six weeks on either side of this one. This one is in the 22nd percentile – i.e., 22% of its contemporaries scored the same or lower than it.