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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Regional and temporal changes in AIDS in Europe before HAART
A Blaxhult1, Z Fox, R Colebunders
1Department of Infectious Disease, Karolinska Hospital, Stockholm, Sweden.
Insights
Regional differences in AIDS-defining events (ADEs) persist. The south-west showed higher risks for Mycobacterium tuberculosis and wasting disease, while the north had increased Mycobacterium avium complex infections.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- AIDS-defining events (ADEs) represent critical disease progression markers.
- Understanding regional variations in ADEs is crucial for targeted public health interventions.
- Previous studies highlighted geographical disparities in the early HIV/AIDS epidemic.
Purpose of the Study:
- To investigate and quantify regional differences in the occurrence of AIDS-defining events (ADEs) across Europe.
- To identify specific ADEs associated with distinct geographical regions.
- To assess the persistence of regional differences observed in earlier phases of the HIV epidemic.
Main Methods:
- Prospective observational study involving 4,485 patients across 46 clinical centers in 17 European countries.
- Data collection included AIDS-defining events (ADEs), demographics, treatment history, and laboratory results from April 1994 to November 1996.
- Cox multivariable regression analyses were employed to compare risks across four defined geographical regions (north, central, south-west, south-east).
Main Results:
- Significant regional variations in ADEs were observed. The south-west region exhibited a higher risk for Mycobacterium tuberculosis infections and wasting disease.
- The north region showed an increased risk of Mycobacterium avium complex (MAC) infections.
- Pneumocystis carinii pneumonia (PCP) was less frequent in the central region compared to other areas.
Conclusions:
- Regional disparities in AIDS-defining events (ADEs) identified in the 1980s persist into the mid-1990s.
- Specific infections like Mycobacterium tuberculosis and Mycobacterium avium complex show distinct geographical clustering.
- These persistent regional differences underscore the need for geographically tailored HIV/AIDS management and prevention strategies.
Abstract:
In a prospective observational study 4,485 patients from 46 clinical centres in 17 European countries were followed between April 1994 and November 1996. Information on AIDS-defining events (ADEs) were collected together with basic demographic data, treatment history and laboratory results. The centres were divided into four geographical regions (north, central, south-west and south-east) so that it was possible to identify any existing regional differences in ADEs. The regional differences that we observed included a higher risk of all forms of Mycobacterium tuberculosis infections (Tb) and wasting disease in the south-west and an increased risk of infections with the Mycobacterium avium complex (MAC) in the north. In Cox multivariable analyses, where north was used as the reference group, we observed hazard ratios of 6.87, 7.77, 2.29 and 0.16 (P < 0.05 in all cases) for pulmonary Tb, extrapulmonary Tb, wasting disease and MAC respectively in the south-west. Pneumocystis carinii pneumonia (PCP) was less commonly diagnosed in the central region (RH = 0.51, 95% CI 0 32-0.79, P = 0.003) and most common in the south-east (RH = 1.04, 95% CI 0.71-1.51, P = 0.85). Comparisons with a similar 'AIDS in Europe' study that concentrated on the early phase of the epidemic reveal that most of the regional differences that were observed in the 1980s still persist in the mid-1990s.
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