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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/μl is associated with improved treatment outcomes in South Africa
AIDS, Volume 24, No. 13, Year 2010
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Description
Objectives: To compare treatment outcomes by starting CD4 cell counts using data from the Comprehensive International Program of Research on AIDS-South Africa trial. DESIGN: An observational cohort study. Methods: Patients presenting to primary care clinics with CD4 cell counts below 350 cells/μl were randomized to either doctor or nurse-managed HIV care and followed for at least 2 years after antiretroviral therapy (ART) initiation. Clinical and laboratory outcomes were compared by baseline CD4 cell counts. Results: Eight hundred and twelve patients were followed for a median of 27.5 months and 36% initiated ART with a CD4 cell count above 200 cells/μl. Although 10% of patients failed virologically, the risk was nearly double among those with a CD4 cell count of 200 cells/μl or less vs. above 200 cells/μl (12.2 vs. 6.8%). Twenty-one deaths occurred, with a five-fold increased risk for the low CD4 cell count group (3.7 vs. 0.7%). After adjustment, those with a CD4 cell count of 200 cells/μl had twice the risk of death/virologic failure [hazard ratio 1.9; 95% confidence interval (CI), 1.1-3.3] and twice the risk of incident tuberculosis (hazard ratio 1.90; 95% CI, 0.89-4.04) as those above 200 cells/μl. Those with either a CD4 cell count of 200 cells/μl or less (hazard ratio 2.1; 95% CI, 1.2-3.8) or a WHO IV condition (hazard ratio 2.9; 95% CI, 0.93-8.8) alone had a two-to-three-fold increased risk of death/virologic failure vs. those with neither, but those with both conditions had a four-fold increased risk (hazard ratio 3.9; 95% CI, 1.9-8.1). We observed some decreased loss to follow-up among those initiating ART at less than 200 cells/μl (hazard ratio 0.79; 95% CI, 0.50-1.25). Conclusion: Patients initiating ART with higher CD4 cell counts had reduced mortality, tuberculosis and less virologic failure than those initiated at lower CD4 cell counts. Our data support increasing CD4 cell count eligibility criteria for ART initiation. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Fox, Matthew P.
United States, Boston
School of Public Health
South Africa, Johannesburg
Health Economics and Epidemiology Research Office
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Sanne, Ian
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Conradie, Francesca M.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Zeinecker, Jennifer
South Africa, Cape Town
University of Cape Town
Orrell, Catherine J.
South Africa, Cape Town
University of Cape Town
Ive, Prudence D.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Rassool, Mohammed Siddique
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Dehlinger, Marjorie
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
van der Horst, Charles Michael
United States, Chapel Hill
The University of North Carolina at Chapel Hill
McIntyre, James Alasdair
South Africa, Johannesburg
Anova Health Institute
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 11
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1097/QAD.0b013e32833c703e
e-ISSN:
14735571
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa