Tuesday, September 21, 2010

The SAPIT trial on trial

HIV and TB, tragically, to go well together. TB is the most common opportunistic infection to arrive when HIV has compromised the body’s immune system. Especially in sub-Saharan Africa, patients who are diagnosed with TB are routinely tested for HIV, and often are found HIV-positive. To compound the misfortune, current effective treatments for TB and HIV are not entirely compatible: starting HIV-positive patients with tuberculosis on antiretroviral treatment can lead to a number of complications, both in terms of toxicities and in terms of adherence (i.e. dual treatment involves taking different drugs daily for a long time). It is important, therefore, to have a clear understanding of the optimal time at which to start antiretroviral treatment with TB patients.

This is what the SAPIT study (South African Starting Antiretroviral Therapy at Three Points in Tuberculosis Therapy) in South Africa attempted to do, and their results were recently published in the prestigious New England Journal of Medicine. But the means taken to answer this important question – the study design – has been a topic of heated debate inside and outside South Africa since March. The design of the study included a sequential arm in which HIV-positive patients would start antiretroviral therapy only after they completed TB treatment or retreatment, a period of six or eight months respectively. This is a long time without antiretroviral therapy, particularly for those patients with advanced disease and low CD4 counts. The results of the study indicate significantly higher mortality in the sequential arm in the study than other arms where antiretroviral treatment was initiated earlier.

The burning ethical question is: was it predictable that those in the sequential arm of the study would experience greater mortality than those in the other arms that started antiretroviral treatment earlier? If the answer is no, the SAPIT study generated new and useful information about late initiation of antiretroviral treatment in this population. If the answer is yes, then the study violated the principle of equipoise, as enshrined in numerous ethical guidelines and regulations.

The SAPIT researchers and their defenders argue that at the time the study took place, little was known about mortality rates for HIV-positive, TB patients who were not on antiretroviral therapy. Accusations about violating equipoise are, from this perspective, criticisms based on hindsight. But a recent article in the South African Medical Journal, authored by some 20 scientists and activists, is having none of it. The authors present the evidence on mortality among patients similar to those in the sequential arm of the SAPIT trial, as was available when the trial was being conducted, as well as (generally underwhelming) evidence about complications of combining TB and HIV treatment. Their findings strongly suggest that those in the sequential arm of the SAPIT trial were given less than the clinical ‘standard of care’.

It is not easy to predict the fallout of the study, now that it is a large blip on the ethics radar. Certainly the South African ethics committees that approved the study are feeling awkward, and the relationship between (some) AIDS researchers and advocates may be strained. The fact that US investigators seemed to be involved in the study (enough to be considered authors) without the study having been reviewed in the US, raises questions about either the regulation of global health research, or the ethics of authorship, or both. The SAMJ article suggests (diplomatically) that the South African ethics committees are simply overwhelmed, but it may more simply a matter of committees inadequately judging a complicated case.

Labels: , , ,

70 Comments:

Blogger Unknown said...

Fantastic post I like the document; love the way you defined things, you are carrying out an incredible task a lot of other people that you by way of of which sort of beneficial sites present consciousness for you to you in connection with many points. We examine various other interesting blogs from your websites along with I am a great deal curious with all your blogging ability, We also began to create content and this sort talk genuinely help me out. We previously book-marked the web site and discussed your own internet sites to the fellow workers not simply us although these like ones blogging and site-building expertise, wish you write far more useful websites like this one particular and best of luck for ones potential websites.

Jimmy Wilson from James Bond Tuxedo

5:18 PM  
Blogger Unknown said...

Great site and a great topic as well I really get amazed to read this. It’s really good. I like viewing web sites which comprehend the price of delivering the excellent useful resource free of charge. Spectre

12:52 AM  
Blogger samish leather said...

Interesting article! Thank you for sharing them! I hope you will continue to have similar posts to share with everyone. movie leather jacket

1:36 AM  
Blogger raybanoutlet001 said...

ugg outlet
replica watches
oakley sunglasses
cleveland cavaliers jerseys
replica watches
michael kors handbags
mbt shoes outlet
louboutin shoes
ferragamo outlet
coach outlet online

11:22 PM  
Blogger jack daniel said...

Your article is great. I like it and your work is marvelous. I really to read it and I wish to read more on this site. Thanks for sharing with us.William Jacket

12:57 PM  
Blogger riscillalauryn91@gmail.com said...

We at Famous Movie jackets offer you a wide range of external wear inspired by famous movies and your beloved celebrities at truly surprising way. Our agenda is to provide you not only a best quality material but lead you to the height of fashion at affordable prices. "Fashion is for everyone" is our slogan thats why we have kept the prices reasonable so that anyone can wear its own style at the same time you will fall in love with the quality for sure once you wear. We deal in celebrity and movie inspired leather jackets in men and women. Not only leather but we have different kind of materials such as denim, cotton, wool etc. Just click on https://www.famousmoviejackets.com and grab your style.

1:36 AM  
Blogger Emma Jason said...

MauveTree have a great collection of leather jackets not only for bikers but for everyone. We use finest leather and remarkable stitching that gives our jackets an attractive look. Not only that we have a variety of different products from delicate stunning jewelry to valuable handmade paintings. Hurry up! Visit our website now to avail exclusive discount offers.

YELLOW & WHITE BIKER LEATHER JACKET

12:19 PM  
Blogger Unknown said...

Better believe it exceptionally decent blog instructive can't locate some other blog website keep your great work and continue blogging God favor you Peace Syndicate Jacob Frye Coat

2:42 AM  
Blogger tech said...

Molto interessante condivido il punto di vista qui potete trovare accessori per drone droni e droni professionali. I droni professionali ( drones ) sono perfetti per termografia ispezioni e fotogrammetria. Nelle ultime tecnologie c'è anche la stampa 3d con la stampe 3d otterrete prototipi e modelli perfetti. La stampante 3d sono insieme ai droni le mie tecnologie preferite

2:15 PM  
Blogger Unknown said...

A decent blog that can locate some direction about that & give a genuinely & make it more others with this blog negan jacket - hjackets

4:06 AM  
Blogger Mickey Mcginnes said...

would recommend. They leak light like you wouldn t believe which may or may not be a good thing, either way I would. spool to increase the tension on the film just don't make it so tight that you can't advance the film. Infinity War Star Lord Leather Jacket

3:34 AM  
Blogger Unknown said...

Better believe it, this is critical and decent article extremely enlightening a debt of gratitude is in order for sharing this. Motorcycle Vest

6:58 AM  
Blogger davidmillar said...

is medically unsafe is like saying wearing socks to bed is medically unsafe. Make sure they aren't too tight and you're fine. Infinity War Winter Soldier Jacket

9:29 AM  
Blogger Mike Rooney said...

I think this is a really good article. You make this information interesting and engaging. I guess I am not only one having all the enjoyment right here! Southside Serpents Jacket

3:15 AM  
Blogger Cyrus Jenix said...

Mens Jacket in uk
Mens Jacket in usa
Spider Men Costume
Captain America
Maxson Battle Coat
Michael Jackson Thriller Jacket
Michael Jackson Beat It Jacket
Blade Runner 2049\

Descendants jacket

9:24 AM  
Blogger Jolly Wolly said...

You make this information interesting and engaging. khwab nama

7:20 AM  
Blogger Julie T. Kirwan said...

green farm 3 mod apk bully anniversary edition mod apk mx player pro apk

5:11 AM  
Blogger Unknown said...

Pj MAsk Party supplies in australia

7:36 AM  
Blogger Leather Jacket said...

This comment has been removed by the author.

3:47 AM  
Blogger Dylan Eales said...

Here at Big Assignments, we continually provide all type of assignments, when anyone searches over internet "all type of assignment help" in Australia. To impose the tendency of doing the work regularly, homeworkassignments and project work are given to the students so that they can have a grip over the subject. If you really want to buy assignment online at a affordable range of price get a touch with sample assignment. We provide subjective based assignment help services like, economics, physics, engineering, nursing, Computer science, Chemistry, science related topics, Along with that you can easily download free assignment sample here.

8:44 AM  
Blogger Unknown said...

abstract wallpapers hd, amazing wallpapers hd, android wallpapers hd, avengers infinity war wallpapers hd, awesome wallpapers hd, background wallpapers hd, batman wallpapers hd, beautiful wallpapers hd, best car wallpapers hd, best lock screen wallpapers hd, best nature wallpapers hd, best wallpapers hd, best wallpapers hd 1080p, best wallpapers hd 4k, best wallpapers hd download, best wallpapers hd for android, best wallpapers hd for iphone, best wallpapers hd for laptop, best wallpapers hd for mobile, best wallpapers hd for pc, best wallpapers hd nature, car wallpapers hd, cool wallpapers hd, desktop wallpapers hd, download best wallpapers hd, download wallpapers hd, download wallpapers hd for mobile, download wallpapers hd for pc, eagle wallpapers hd, edge wallpapers hd, eminem wallpapers hd, emoji wallpapers hd, flowers wallpapers hd, football wallpapers hd, free download wallpapers hd, free wallpapers hd, full screen wallpapers hd, girl wallpapers hd, good wallpapers hd, hd is wallpapers, hd wallpapers hd 1080p, hd wallpapers hd 1920x1080, hd wallpapers hd 4k, hd wallpapers hd download, hd wallpapers quotes for mobile, how to download full hd wallpapers, how to download hd wallpapers, how to download hd wallpapers for android, how to download hd wallpapers for desktop, how to download hd wallpapers for iphone,


visit this websit to download full hd wallpapers:

https://www.trywallpapers.com/

6:39 AM  
Blogger Jennifer Aniston said...

Excellent and helpful information on your web page washington coat . I appreciate this content writer for this content. Thank you for shearing your information and ideas with us

7:22 AM  
Blogger kane walliamson said...

I love the style of your writing articles. rocketeer jacket It just amazing. The blog post is very connective and attractive. All the information I found in post is very useful.

7:06 AM  
Blogger dawson_here said...

Great Blog! I should need to thank for the endeavors you have made in shaping this post. I am trusting in a practically identical best work from you later on also. I expected to thank you for these districts! A commitment of gratefulness is altogether to share. kim kardashian leather jackets

8:40 AM  
Blogger zacklee said...

Good to see such those informative articles. Thanks for sharing with us.
Klaus Umbrella Academy Coat

4:46 AM  
Blogger Maria Garcia said...

Whenever I came across any difficulty, I often used to search “who can do my assignment for me”, but, later on realised that there are many these type of services who promises a lot but does only a little. However, My Assignment Services is one such assignment provider who believe only in the quality. They are exactly the type of assignment service provider that I needed from a long time. By opting their services, you get assistance to a lot of subjects including their nursing assignment help, management, law, engineering, finance, economics, accounting, and a lot more. Therefore, you need not to be worry, instead go for My Assignment Services by visiting the link.

6:27 AM  
Blogger Lara Gargett said...

After reading this blog, I understood how students make mistakes in Assignment. However, the experts of Online Assignment Expert provide unique online assignment help . To students all across Australia. This is ensured by the multi-levels of quality checks that make the assignments error-free. Obviously, the assignments would furnish every guideline of the marking rubric.
As a student, I have availed off their services frequently as I feel their nursing assignment helpexperts are master at whatever they do. I have observed the kind of precision that they display in their work, thereby providing me with an impeccable assignment.

3:47 AM  
Blogger Cyrus Jenix said...

Fairytelnews ....



Walt Longmire Coat

Joker Jacket

Blade Runner Coat

Carlos descendants costume

Puffer Jacket

Endgame Costume

gorilla costume

12:22 PM  
Blogger Mike Rooney said...

There is excellent and helpful information about ear wax problems on Web Md. Go to this web site. Atom Cats Jacket

1:52 PM  
Blogger yanmaneee said...

balenciaga shoes
retro jordans
christian louboutin shoes
michael jordan shoes
supreme clothing
off white clothing
jordan shoes
hermes handbags
nike react
nfl store

3:49 AM  
Blogger jorgemichael said...

There is excellent and helpful information about ear wax problems on Web Md. Go to this web site. Star Lord Jacket

11:55 AM  
Blogger Ummah Charity International said...

Donate Sadaqah online. Thanks for Sharing.

6:00 AM  
Blogger BagyWagy said...

Great article you post. Halloween outfits for adults. Thanks for Sharing.

7:36 AM  
Blogger cristinajohn said...

Halloween Sale Thanks for Sharing.

1:58 AM  
Blogger Mike Rooney said...

There is an excellent tutorial for those who are new to family research at counties within those states. Then there is Rootsweb at.
Grease T Birds Jacket

5:33 AM  
Blogger cristinajohn said...

This Captain America Civil War Jacket is must have for all superheroes devotees. Pick your desired outfit at best reasonable price.

4:21 AM  
Blogger Unknown said...

Another great thing about us is that we have on offer jackets of greatly different prices; from high-quality premium The Game Leather Jackets jackets to quite low-priced ones.

2:21 AM  
Blogger Mike Rooney said...

I think this is great event and finally want to say thanks for sharing event photos. Jumanji The Next Level Spencer Vest

12:11 PM  
Blogger Brukkevin said...

Fantastic blog i have never ever read this type of amazing information. Skyfall Leather Jacket

7:37 AM  
Blogger Morgan Kunz said...

Get the most exciting and loving friendship story ofBad Boys For Life Jacket nowhere for you to shop and take your friendship to the new level. Shop Today!

4:44 AM  
Blogger Skinoutfits said...

Great blog here!
Captain Marvel Carol Danvers Jacket

8:55 AM  
Blogger Skinoutfits said...

Looks amazing, I m just give this a good , thanks for posting, great blog!
Avengers Hoodie

5:09 AM  
Blogger Kaylee Bryson said...

Great blog! Thank you so much for sharing a lovely post. I appreciate to blogger for helpful sharing
Brown Shearling Leather Bane Coat

1:58 AM  
Blogger DaniyalAhmed said...

Thanks For Sharing Such An Interesting Article, It Is Really Worthy To Read. I Have Subscribed To You And From Now On I'll Check Your Profile Daily For Interesting Stuffs. Finn Star Wars Jacket

4:43 AM  
Blogger Mike Rooney said...

Thanks For Sharing Such An Interesting Article, It Is Really Worthy To Read.Onward Denim Vest

7:45 AM  
Blogger Alvis John said...

Hello I'm Grab Jacket i work hard for leathers jacket and i knew that you like our site so visit our site Brown Leather Jackets At Grab Jackets

5:36 AM  
Blogger shopify said...

software development company with 8 years of experience in the industry, you can take a look at our various successful projects. ITSolution24x7 has executed groundbreaking ideas for different purposes and spheres. But the one single thing that never changes is our quality and dedication. To share and prove our expertise, here are a few case studies for you.

11:49 AM  
Blogger yanmaneee said...

yeezys
air max
supreme clothing
nike air max 2017
curry 7
yeezy shoes
longchamp handbags
nike air vapormax
jordan shoes
longchamp outlet

11:39 PM  
Blogger riscillalauryn91@gmail.com said...

This is such awesome content i got to read after lot of time. Its so interesting as well as informative. I am sure everyone who read it got a lot to learn from it. Freddie Mercury Jacket

4:11 AM  
Blogger Admin said...

Super Celeb Jacket aim to get people to be as stylish and fashionable as their favorite celebs and singers, as they are shown in films, dramas, cosplay and music videos.

11:39 AM  
Blogger Unknown said...

HIV TB and or such types of infection are very dangerous. we have to fight with it at every possible way. You can start a web site from Reseller Host Provider uploading post, start campaigning and invite interested people for volunteering.

2:49 AM  
Blogger shopify said...

Here on our online shopping store, you can from choose from ethnic shrugs, summer jackets, WWE Wrestling Jackets, winter jackets and more.

6:52 AM  
Blogger Mike Rooney said...

I really enjoyed reading your article.Mens Navy Blue Leather Jacket

1:44 PM  
Blogger Mussawir said...

I really admired your post, such great and useful information that you have mentioned here. Achasoda

2:50 AM  
Blogger bretl460 said...

Are You Looking for a Reliable mental health case study assignment? Assignment Studio Provides Professional Assignment Writing Services With Top-quality Assignment With 100% Free Plagiarism.

6:01 AM  
Blogger bretl460 said...

Need academic essay writing services au ? Hire Phd Qualified Writers in Australia at Affordable Prices.

6:02 AM  
Blogger Unknown said...

Best New Love Quotes Everyone searches the internet and you find many websites like our website LoveQuotesG.Com

Brother Love Quotes

Engagement Love Quotes

Whatsapp Quotes

Best New Faith Quotes

New Monday Quotes

8:11 AM  
Blogger Mike Rooney said...

It looks like you've spent a lot of time and effort on your blog.Rip Yellowstone Jacket


9:58 AM  
Blogger Sarah Winget said...

For most of the university students, research paper has a huge rate towards their course grade, this is one of the significant explanation students are relied upon to compose their research papers appropriately. In the event that you don't get the fundamentals right, than scoring passing marks would be a major issue. So why hazard your grade, for what reason don't get proficient assignment help from a group of master academic writers. essay writing help , assignmenthelp

3:14 AM  
Blogger Ricky Peter said...

Hey guys check it out it's a very helpful website that will help you out a lot just trust me yelena belova jacket

5:04 AM  
Blogger Ricky Peter said...

This comment has been removed by the author.

5:05 AM  
Blogger Ricky Peter said...

I have read john dutton wool vest this wonderful post very Good so thank you for sharing it.

5:06 AM  
Blogger calvin harris said...

Thank you for sharing this useful and informative news jeffrey leonard attorney

9:50 AM  
Blogger calvin harris said...

I like this topic that you have written in a detail. Thank you for this great resource. It helped me a lot and please keep sharing more with us. Turmeric Facial Cleanser

9:50 AM  
Blogger calvin harris said...

thnks for your article it nice i have some ideas for you please us content. Gisinsulation

9:51 AM  
Blogger LerenJack said...

This is the first time that I visit here. I found so many exciting matters in this particular blog, One thing I would like to request you that pls keep posting such type of informative blog Ted Lasso Collection

5:14 AM  
Blogger earnkaroge said...

site is fantastic. I always find great knowledge from it. घर बैठे रोजगार के तरीके earnkaroge

2:25 AM  
Blogger Unknown said...

Awesome post its very informative

A2 pilot jacket

Men's Leather Vests

3:58 AM  
Blogger Zainiseowriter said...

Thanks for sharing this awesome post it was very informative Plz share more post like this.

WOMEN LEATHER BOMBER JACKETS

MENS FLYING LEATHER JACKET

MEN LEATHER VEST

12:28 AM  
Blogger Lalit Verma said...

hanks you For Sharing This Post Paise kamane ke tarike
Paise kamane wala gamee
Paise kamane wala apps
funny birthday wishes in hindi

YouTube Channel Kaise Banaye

train wala game download

9:40 PM  

Post a Comment

<< Home