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

Simple item page
dc.contributor.authorZeinecker, Jennifer
dc.contributor.authorOrrell, Catherine
dc.contributor.authorWood, Robin
dc.date.accessioned2016-07-29T12:10:26Z
dc.date.available2016-07-29T12:10:26Z
dc.date.issued2010
dc.date.updated2016-06-09T10:54:15Z
dc.description.abstractObservational 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.identifierhttp://dx.doi.org/10.1097/QAD.0b013e32833c703e
dc.identifier.apacitationZeinecker, J., Orrell, C., & Wood, R. (2010). Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa. <i>AIDS</i>, http://hdl.handle.net/11427/21030en_ZA
dc.identifier.chicagocitationZeinecker, Jennifer, Catherine Orrell, and Robin Wood "Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa." <i>AIDS</i> (2010) http://hdl.handle.net/11427/21030en_ZA
dc.identifier.citationFox, 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.issn0269-9370
dc.identifier.ris TY - Journal Article AU - Zeinecker, Jennifer AU - Orrell, Catherine AU - Wood, Robin AB - 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. DA - 2010 DB - OpenUCT DP - University of Cape Town J1 - AIDS KW - Human Immunodeficiency Virus KW - Sub-Saharan Africa KW - Highly Active Antiretroviral Therapy KW - CD4 count KW - Mortality KW - Virologic Failure KW - Tuberculosis LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 SM - 0269-9370 T1 - Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa TI - Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa UR - http://hdl.handle.net/11427/21030 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/21030
dc.identifier.urihttp://europepmc.org/articles/pmc2914833
dc.identifier.vancouvercitationZeinecker J, Orrell C, Wood R. Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa. AIDS. 2010; http://hdl.handle.net/11427/21030.en_ZA
dc.language.isoeng
dc.publisherWolters Kluwer Health
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceAIDS
dc.source.urihttp://journals.lww.com/aidsonline/pages/default.aspx
dc.subjectHuman Immunodeficiency Virus
dc.subjectSub-Saharan Africa
dc.subjectHighly Active Antiretroviral Therapy
dc.subjectCD4 count
dc.subjectMortality
dc.subjectVirologic Failure
dc.subjectTuberculosis
dc.titleInitiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Zeinecker_Initiating_patients_on_2010.pdf
Size:
320.32 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Journal Articles