CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa

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dc.contributor.authorLawn, Stephenen_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.date.accessioned2015-10-12T10:51:48Z
dc.date.available2015-10-12T10:51:48Z
dc.date.issued2006en_ZA
dc.description.abstractBACKGROUND:Patients accessing antiretroviral treatment (ART) programmes in sub-Saharan Africa frequently have very advanced immunodeficiency. Previous data suggest that such patients may have diminished capacity for CD4 cell count recovery. METHODS: Rates of CD4 cell increase were determined over 48 weeks among ART-naive individuals (n = 596) commencing ART in a South African community-based ART programme. RESULTS: The CD4 cell count increased from a median of 97 cells/mul at baseline to 261 cells/mul at 48 weeks and the proportion of patients with a CD4 cell count <100 cells/mul decreased from 51% at baseline to just 4% at 48 weeks. A rapid first phase of recovery (0-16 weeks, median rate = 25.5 cells/mul/month) was followed by a slower second phase (16-48 weeks, median rate = 7.7 cells/mul/month). Compared to patients with higher baseline counts, multivariate analysis showed that those with baseline CD4 counts <50 cells/mul had similar rates of phase 1 CD4 cell recovery (P = 0.42), greater rates of phase 2 recovery (P = 0.007) and a lower risk of immunological non-response (P = 0.016). Among those that achieved a CD4 cell count >500 cells/mul at 48 weeks, 19% had baseline CD4 cell counts <50 cells/mul. However, the proportion of these patients that attained a CD4 count 200 cells/mul at 48 weeks was lower than those with higher baseline CD4 cell counts. CONCLUSION: Patients in this cohort with baseline CD4 cell counts <50 cells/mul have equivalent or greater capacity for immunological recovery during 48 weeks of ART compared to those with higher baseline CD4 cell counts. However, their CD4 counts remain <200 cells/mul for a longer period, potentially increasing their risk of morbidity and mortality in the first year of ART.en_ZA
dc.identifier.apacitationLawn, S., Myer, L., Bekker, L., & Wood, R. (2006). CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14167en_ZA
dc.identifier.chicagocitationLawn, Stephen, Landon Myer, Linda-Gail Bekker, and Robin Wood "CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa." <i>BMC Infectious Diseases</i> (2006) http://hdl.handle.net/11427/14167en_ZA
dc.identifier.citationLawn, S. D., Myer, L., Bekker, L. G., & Wood, R. (2006). CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa. BMC infectious diseases, 6(1), 59.en_ZA
dc.identifier.ris TY - Journal Article AU - Lawn, Stephen AU - Myer, Landon AU - Bekker, Linda-Gail AU - Wood, Robin AB - BACKGROUND:Patients accessing antiretroviral treatment (ART) programmes in sub-Saharan Africa frequently have very advanced immunodeficiency. Previous data suggest that such patients may have diminished capacity for CD4 cell count recovery. METHODS: Rates of CD4 cell increase were determined over 48 weeks among ART-naive individuals (n = 596) commencing ART in a South African community-based ART programme. RESULTS: The CD4 cell count increased from a median of 97 cells/mul at baseline to 261 cells/mul at 48 weeks and the proportion of patients with a CD4 cell count <100 cells/mul decreased from 51% at baseline to just 4% at 48 weeks. A rapid first phase of recovery (0-16 weeks, median rate = 25.5 cells/mul/month) was followed by a slower second phase (16-48 weeks, median rate = 7.7 cells/mul/month). Compared to patients with higher baseline counts, multivariate analysis showed that those with baseline CD4 counts <50 cells/mul had similar rates of phase 1 CD4 cell recovery (P = 0.42), greater rates of phase 2 recovery (P = 0.007) and a lower risk of immunological non-response (P = 0.016). Among those that achieved a CD4 cell count >500 cells/mul at 48 weeks, 19% had baseline CD4 cell counts <50 cells/mul. However, the proportion of these patients that attained a CD4 count 200 cells/mul at 48 weeks was lower than those with higher baseline CD4 cell counts. CONCLUSION: Patients in this cohort with baseline CD4 cell counts <50 cells/mul have equivalent or greater capacity for immunological recovery during 48 weeks of ART compared to those with higher baseline CD4 cell counts. However, their CD4 counts remain <200 cells/mul for a longer period, potentially increasing their risk of morbidity and mortality in the first year of ART. DA - 2006 DB - OpenUCT DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa TI - CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa UR - http://hdl.handle.net/11427/14167 ER - en_ZA
dc.identifier.uri10.1186/1471-2334-6-59en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14167
dc.identifier.vancouvercitationLawn S, Myer L, Bekker L, Wood R. CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa. BMC Infectious Diseases. 2006; http://hdl.handle.net/11427/14167.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherAntiretroviral treatment outcomesen_ZA
dc.titleCD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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