PMID- 30707696
OWN - NLM
STAT- MEDLINE
DCOM- 20191029
LR  - 20200309
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 14
IP  - 2
DP  - 2019
TI  - Treatment of HIV among tuberculosis patients: A replication study of timing of 
      antiretroviral therapy for HIV-1-associated tuberculosis.
PG  - e0210327
LID - 10.1371/journal.pone.0210327 [doi]
LID - e0210327
AB  - Co-diagnosis of HIV and tuberculosis presents a treatment dilemma. Starting both 
      treatments at the same time can cause a flood of immune response called immune 
      reconstitution inflammatory syndrome (IRIS) which can be lethal. But, how long to 
      delay HIV treatment is less understood. In 2011, based on the conclusions of 
      three separate studies, WHO recommended starting HIV treatment earlier for those 
      with later HIV disease progression. This paper conducts a replication study of 
      one of the three studies, by Havlir and colleagues. Using their publicly 
      available data, we were able to replicate most of the results presented in the 
      original paper. In our measurement and estimation analyses we use different 
      estimation techniques to assess the robustness of the results. We find that 
      adjusting for loss to follow-up does not affect the main results of the paper. 
      However, an ANCOVA estimation and an instrumental variable model weaken the main 
      result of the paper of better outcomes with early HIV treatment only for those 
      who are sicker, reducing significance from the 5% to the 10% level. A 
      change-point analysis also detects no changes in effect by timing of HIV 
      treatment initiation or different thresholds of CD4 count for the primary 
      outcome. This result suggests that the choice of start time for HIV treatment 
      initiation should be based on other factors including potential drug 
      interactions, overlapping side effects, a high pill burden and severity of 
      illness rather than CD4 threshold and preset timeframes. While we caution against 
      overgeneralizing, the result of this replication is aligned with more recent 
      studies that show no evidence that early initiation of HIV treatment reduces 
      mortality for any patients.
FAU - Djimeu, Eric W
AU  - Djimeu EW
AD  - International Initiative for Impact Evaluation (3ie), Washington, DC, United 
      States of America.
AD  - CEREG, University of Yaounde II, Yaounde, Cameroon.
FAU - Heard, Anna C
AU  - Heard AC
AUID- ORCID: 0000-0002-5900-1601
AD  - International Initiative for Impact Evaluation (3ie), Washington, DC, United 
      States of America.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190201
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adult
MH  - Anti-Retroviral Agents/*administration & dosage
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - Follow-Up Studies
MH  - *HIV Infections/blood/drug therapy/mortality
MH  - *HIV-1
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Models, Biological
MH  - *Tuberculosis/blood/mortality
PMC - PMC6358155
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/02/02 06:00
MHDA- 2019/10/30 06:00
PMCR- 2019/02/01
CRDT- 2019/02/02 06:00
PHST- 2018/07/03 00:00 [received]
PHST- 2018/12/20 00:00 [accepted]
PHST- 2019/02/02 06:00 [entrez]
PHST- 2019/02/02 06:00 [pubmed]
PHST- 2019/10/30 06:00 [medline]
PHST- 2019/02/01 00:00 [pmc-release]
AID - PONE-D-18-18687 [pii]
AID - 10.1371/journal.pone.0210327 [doi]
PST - epublish
SO  - PLoS One. 2019 Feb 1;14(2):e0210327. doi: 10.1371/journal.pone.0210327. 
      eCollection 2019.