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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
CD4 decline and incidence of opportunistic infections in Cape Town, South Africa: Implications for prophylaxis and treatment
Journal of Acquired Immune Deficiency Syndromes, Volume 42, No. 4, Year 2006
Notification
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Description
OBJECTIVES: To determine the rate of CD4 decline and the incidence of opportunistic infections (OIs) among antiretroviral therapy-naive South African HIV-infected patients and inform timing of OI prophylaxis. METHODS: We used mixed-effect models to estimate CD4 cell decline by CD4 cell count strata in HIV-infected patients in the Cape Town AIDS Cohort between 1984 and 2000. Stratum-specific OI incidence per 100 person-years of observation was determined using incidence density analysis. RESULTS: Nine hundred seventy-four patients with 2 or more CD4 cell counts were included. CD4 counts declined by 47.1 cells/μL per year in the stratum with more than 500 cells/μL stratum, 30.6 cells/μL per year in the stratum with 351 to 500 cells/μL, and 20.5 cells/μL per year in the stratum with 201 to 350 cells/μL. Tuberculosis and oral candidiasis were the only OIs that occurred frequently in the stratum with more than 200 CD4 cells/μL. Rates of chronic diarrhea, wasting syndrome, tuberculosis, and oral and esophageal candidiasis increased in the stratum with less than 200 cells/μL, and rates of all OIs were highest in the stratum with 50 cells/μL or less. CONCLUSIONS: CD4 cell count declines were dependent on CD4 strata and can inform timing of clinic visits and treatment initiation in South Africa. Incidence rates of OIs suggest that targeted OI prophylaxis could prevent substantial HIV-related morbidity in South Africa. Copyright © 2006 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Holmes, Charles B.
United States, Boston
Massachusetts General Hospital
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Badri, Motasim A.
South Africa, Cape Town
University of Cape Town
Zilber, Sophia
United States, Boston
Massachusetts General Hospital
Wang, Bingxia
United States, Boston
Massachusetts General Hospital
United States, Boston
Boston University
Maartens, Gary Tuberculosis
South Africa, Cape Town
University of Cape Town
Zheng, Hui
United States, Boston
Massachusetts General Hospital
Lu, Zhigang
United States, Boston
Massachusetts General Hospital
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Boston University
Losina, Elena
United States, Boston
Boston University
Statistics
Citations: 189
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1097/01.qai.0000225729.79610.b7
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa