Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies

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dc.contributor.authorNash, Denis
dc.contributor.authorKatyal, Monica
dc.contributor.authorBrinkhof, Martin W G
dc.contributor.authorKeiser, Olivia
dc.contributor.authorMay, Margaret
dc.contributor.authorHughes, Rachael
dc.contributor.authorDabis, Francois
dc.contributor.authorWood, Robin
dc.contributor.authorSprinz, Eduardo
dc.contributor.authorSchechter, Mauro
dc.contributor.authorEgger, Matthias
dc.date.accessioned2016-08-11T09:42:14Z
dc.date.available2016-08-11T09:42:14Z
dc.date.issued2008
dc.date.updated2016-06-09T10:53:38Z
dc.description.abstractBackground: Few data are available on the long-term immunologic response to ART in resource-limited settings, where antiretroviral therapy (ART) is being scaled up using a public health approach, with a limited repertoire of drugs. Objectives: To describe immunologic response to ART in a network of cohorts from sub-Saharan Africa, Latin America, and Asia. Study population/methodsL: Treatment-naïve patients aged 15 and older from 27 treatment programs were eligible. Multi-level, linear mixed models were used to assess associations between predictor variables and CD4 count trajectories following ART initiation. Results: Of 29,175 patients initiating ART, 8,933 patients (31%) were excluded due to insufficient follow-up time and early lost to follow-up or death. The remaining 19,967 patients contributed 39,200 person-years on ART and 71,067 CD4 measurements. The median baseline CD4 count was 114 cells/μL, with 35%<100 cells μL and substantial inter-site variation (range: 61-181 cells/μL). Females had higher median baseline CD4 counts than males (121 vs. 104 cells/μL). The median CD4 count increased from 114 cells/μL at ART initiation to 230 (IQR:144-338) at 6 months, 263 (IQR:175-376) at 1 year, 336 (IQR:224-472) at 2 years, 372 (IQR:242-537) at 3 years, 377 (IQR:221-561) at 4 years, and 395 (IQR:240-592) at 5 years. In multivariable models, baseline CD4 count was the most important determinant of subsequent CD4 count trajectories. Conclusions: These data demonstrate robust and sustained CD4 response to ART among patients remaining on therapy. Public health and programmatic interventions leading to earlier HIV diagnosis and initiation of ART could substantially improve patient outcomes in resource-limited settings.
dc.identifierhttp://dx.doi.org/10.1097/QAD.0b013e3283121ca9
dc.identifier.apacitationNash, D., Katyal, M., Brinkhof, M. W. G., Keiser, O., May, M., Hughes, R., ... Egger, M. (2008). Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies. <i>AIDS</i>, http://hdl.handle.net/11427/21164en_ZA
dc.identifier.chicagocitationNash, Denis, Monica Katyal, Martin W G Brinkhof, Olivia Keiser, Margaret May, Rachael Hughes, Francois Dabis, et al "Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies." <i>AIDS</i> (2008) http://hdl.handle.net/11427/21164en_ZA
dc.identifier.citationNash, D., Katyal, M., Brinkhof, M. W., Keiser, O., May, M., Hughes, R., ... & Egger, M. (2008). Long-term immunologic response to antiretroviral therapy in low-income countries: Collaborative analysis of prospective studies: The Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration of the International epidemiological Databases to Evaluate AIDS. AIDS (London, England), 22(17), 2291.
dc.identifier.ris TY - Journal Article AU - Nash, Denis AU - Katyal, Monica AU - Brinkhof, Martin W G AU - Keiser, Olivia AU - May, Margaret AU - Hughes, Rachael AU - Dabis, Francois AU - Wood, Robin AU - Sprinz, Eduardo AU - Schechter, Mauro AU - Egger, Matthias AB - Background: Few data are available on the long-term immunologic response to ART in resource-limited settings, where antiretroviral therapy (ART) is being scaled up using a public health approach, with a limited repertoire of drugs. Objectives: To describe immunologic response to ART in a network of cohorts from sub-Saharan Africa, Latin America, and Asia. Study population/methodsL: Treatment-naïve patients aged 15 and older from 27 treatment programs were eligible. Multi-level, linear mixed models were used to assess associations between predictor variables and CD4 count trajectories following ART initiation. Results: Of 29,175 patients initiating ART, 8,933 patients (31%) were excluded due to insufficient follow-up time and early lost to follow-up or death. The remaining 19,967 patients contributed 39,200 person-years on ART and 71,067 CD4 measurements. The median baseline CD4 count was 114 cells/μL, with 35%<100 cells μL and substantial inter-site variation (range: 61-181 cells/μL). Females had higher median baseline CD4 counts than males (121 vs. 104 cells/μL). The median CD4 count increased from 114 cells/μL at ART initiation to 230 (IQR:144-338) at 6 months, 263 (IQR:175-376) at 1 year, 336 (IQR:224-472) at 2 years, 372 (IQR:242-537) at 3 years, 377 (IQR:221-561) at 4 years, and 395 (IQR:240-592) at 5 years. In multivariable models, baseline CD4 count was the most important determinant of subsequent CD4 count trajectories. Conclusions: These data demonstrate robust and sustained CD4 response to ART among patients remaining on therapy. Public health and programmatic interventions leading to earlier HIV diagnosis and initiation of ART could substantially improve patient outcomes in resource-limited settings. DA - 2008 DB - OpenUCT DO - 10.1097/QAD.0b013e3283121ca9 DP - University of Cape Town J1 - AIDS KW - antiretroviral therapy KW - CD4 response KW - CD4 lymphocyte count KW - low-income countries KW - baseline CD4 count KW - ART-LINC KW - IeDEA LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies TI - Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies UR - http://hdl.handle.net/11427/21164 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/21164
dc.identifier.urihttp://dx.doi.org/10.1097/QAD.0b013e3283121ca9
dc.identifier.vancouvercitationNash D, Katyal M, Brinkhof MWG, Keiser O, May M, Hughes R, et al. Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies. AIDS. 2008; http://hdl.handle.net/11427/21164.en_ZA
dc.language.isoeng
dc.publisherLippincott, Williams & Wilkins
dc.publisher.departmentDivision of Immunologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceAIDS
dc.source.urihttp://www.lww.com/product/?0269-9370
dc.subjectantiretroviral therapy
dc.subjectCD4 response
dc.subjectCD4 lymphocyte count
dc.subjectlow-income countries
dc.subjectbaseline CD4 count
dc.subjectART-LINC
dc.subjectIeDEA
dc.titleLong-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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