Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa

 

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dc.contributor.author Zeinecker, Jennifer
dc.contributor.author Orrell, Catherine
dc.contributor.author Wood, Robin
dc.date.accessioned 2016-07-29T12:10:26Z
dc.date.available 2016-07-29T12:10:26Z
dc.date.issued 2010
dc.identifier http://dx.doi.org/10.1097/QAD.0b013e32833c703e
dc.identifier.citation Fox, M. P., Sanne, I. M., Conradie, F., Zeinecker, J., Orrell, C., Ive, P., ... & Wood, R. (2010). Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/microl is associated with improved treatment outcomes in South Africa. AIDS (London, England), 24(13), 2041-2050.
dc.identifier.issn 0269-9370
dc.identifier.uri http://hdl.handle.net/11427/21030
dc.identifier.uri http://europepmc.org/articles/pmc2914833
dc.description.abstract Observational cohort study. Methods Patients presenting to primary care clinics with CD4 cell counts <350 cells/mm3 were randomized to either doctor- or nurse-managed HIV care and followed for at least two years after ART initiation. Clinical and laboratory outcomes were compared by baseline CD4 count. Results 812 patients were followed for a median of 27.5 months and 36% initiated with a CD4 count >200. While 10% of patients failed virologically (VF), the risk was nearly double among those with a CD4 ≤200 vs. >200 (12.2% vs. 6.8%). 21 deaths occurred, with a five-fold increased risk for the low CD4 group (3.7% vs. 0.7%). After adjustment, those with a CD4 count ≤200 had twice the risk of death/VF (HR 1.9; 95% CI: 1.1–3.3) and twice the risk of incident tuberculosis (HR: 1.90; 95% CI: 0.89–4.04) as those >200. Those with either a CD4 ≤200 (HR 2.1; 1.2–3.8) or a WHO IV condition (HR 2.9; 0.93–8.8) alone had a two to three-fold increased risk of death/VF vs. those with neither, but those with both conditions had a 4-fold increased risk (HR 3.9; 95% CI: 1.9–8.1). We observed some increased loss to follow-up among those initiating <200 (HR 0.79; 95% CI: 0.50–1.25). Conclusions Patients initiating ART with higher CD4 counts had reduced mortality, tuberculosis and less virologic failure than those initiated at lower CD4 counts. Our data support increasing CD4 count eligibility criteria for ART initiation.
dc.publisher Wolters Kluwer Health
dc.source AIDS
dc.source.uri http://journals.lww.com/aidsonline/pages/default.aspx
dc.subject Human Immunodeficiency Virus
dc.subject Sub-Saharan Africa
dc.subject Highly Active Antiretroviral Therapy
dc.subject CD4 count
dc.subject Mortality
dc.subject Virologic Failure
dc.subject Tuberculosis
dc.title Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa
dc.type Journal Article en_ZA
dc.date.updated 2016-06-09T10:54:15Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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