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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
CD4 cell count and initiation of antiretroviral therapy: Trends in seven UK centres, 1997-2003
HIV Medicine, Volume 8, No. 3, Year 2007
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Description
Objectives: We examined whether the timing of initiation of antiretroviral therapy (ART) in routine clinical practice reflected treatment guidelines, which have evolved towards recommending starting therapy at lower CD4 cell counts. Methods: We analysed longitudinal data on 10 820 patients enrolled in the UK Collaborative HIV Cohort (UK CHIC) Study, which includes seven large clinical centres in south-east England. CD4 cell and viral load measurements performed in the period between 1 January 1997 and 31 December 2003 were classified according to whether ART was subsequently initiated or deferred, to estimate the probability of ART initiation by CD4 count and viral load over time. The effect of nonclinical factors (age, sex, ethnicity, and exposure category) was analysed by logistic regression. Kaplan-Meier analysis was used to estimate the proportion of patients who had initiated ART by a particular CD4 count among 'early' presenters (initial CD4 cell count >500 cells/μL). Results: There was a tendency to initiate ART at lower CD4 cell counts over time in the years 1997-2000, especially in the range 200-500 cells/μL, with little change thereafter. An estimated 34% of HIV-infected individuals having presented early initiated ART at a CD4 count <200 cells/μL. We also found an independent influence of viral load, which was particularly pronounced for CD4 <350 cells/μL. Use of injection drugs was the only nonclinical factor associated with initiation of ART at lower CD4 cell counts. Conclusions: The initiation of ART in the clinics included in this analysis reflected evolving treatment guidelines. However, an unexpectedly high proportion of patients started ART at lower CD4 counts than recommended, which is only partly explained by late presentation. © 2007 British HIV Association.
Authors & Co-Authors
Stöhr, Wolfgang
United Kingdom, London
Mrc Clinical Trials Unit
Dunn, David T.
United Kingdom, London
Mrc Clinical Trials Unit
United Kingdom, London
Medical Research Council
Porter, Kholoud
United Kingdom, London
Mrc Clinical Trials Unit
United Kingdom, London
Medical Research Council
Hill, Teresa
United Kingdom, London
Ucl Medical School
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Walsh, John Christopher
United Kingdom, London
Imperial College Healthcare Nhs Trust
United Kingdom, London
St Mary's Hospital
Gilson, Richard John Cary
United Kingdom, London
University College London
Easterbrook, Philippa Jane
United Kingdom, London
Faculty of Life Sciences & Medicine
United Kingdom, London
King's College Hospital
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Johnson, Margaret A.
United Kingdom, London
The Royal Free Hospital
United Kingdom, London
Ucl Medical School
Delpech, Valerie C.
United Kingdom, London
Public Health England
Phillips, Andrew N.
United Kingdom, London
Ucl Medical School
Sabin, Caroline Anne
United Kingdom, London
Ucl Medical School
Ainsworth, Jonathan G.
Unknown Affiliation
Anderson, Jane
United Kingdom, London
Mrc Clinical Trials Unit
Babiker, Abdel G.A.G.
United Kingdom, London
Medical Research Council
Gompels, Mark M.
Unknown Affiliation
Leen, Clifford L.S.
Unknown Affiliation
Orkin, Chloë M.
United Kingdom, London
Barts Health Nhs Trust
Morris, Lynn G.
Unknown Affiliation
Schwenk, Achim
Unknown Affiliation
Bansi-Matharu, Loveleen K.
United Kingdom, London
Ucl Medical School
Patel, Sandeep D.
United Kingdom, London
Medical Research Council
Sheehan, Stephen
United Kingdom, London
Medical Research Council
Bazuaye, Eghosa A.
United Kingdom, London
King's College Hospital
Perry, Nicky
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Churchill, Duncan R.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Mandalia, Sundhiya
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Dodds, Julie P.
United Kingdom, London
University College London
Williams, Ian G.
United Kingdom, London
University College London
Youle, Mike S.
United Kingdom, London
Ucl Medical School
Lampe, Fiona C.
United Kingdom, London
Ucl Medical School
Chaloner, Clinton
United Kingdom, London
Ucl Medical School
Puradiredja, Dewi Ismajani
United Kingdom, London
Ucl Medical School
Weber, Jonathan N.
United Kingdom, London
St Mary's Hospital
Kemble, Christian
United Kingdom, London
St Mary's Hospital
Hand, James
United Kingdom, London
Barts Health Nhs Trust
Wilson, Alan C.
Unknown Affiliation
Statistics
Citations: 39
Authors: 38
Affiliations: 14
Identifiers
Doi:
10.1111/j.1468-1293.2007.00443.x
ISSN:
14681293
Research Areas
Infectious Diseases
Study Design
Cohort Study