TY - JOUR
T1 - Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs
AU - AUTHOR GROUP
AU - Anderegg, Nanina
AU - Panayidou, Klea
AU - Abo, Yao
AU - Alejos, Belen
AU - Althoff, Keri N.
AU - Anastos, Kathryn
AU - Antinori, Andrea
AU - Balestre, Eric
AU - Becquet, Renaud
AU - Castagna, Antonella
AU - Castelnuovo, Barbara
AU - Chêne, Geneviève
AU - Coelho, Lara
AU - Collins, Intira Jeannie
AU - Costagliola, Dominique
AU - Crabtree-Ramírez, Brenda
AU - Dabis, Francois
AU - D'Arminio Monforte, Antonella
AU - Davies, Mary-Ann
AU - de Wit, Stéphane
AU - Delpech, Valérie
AU - de La Mata, Nicole L.
AU - Duda, Stephany
AU - Freeman, Aimee
AU - Gange, Stephen J.
AU - Grabmeier-Pfistershammer, Katharina
AU - Gunsenheimer-Bartmeyer, Barbara
AU - Jiamsakul, Awachana
AU - Kitahata, Mari M.
AU - Law, Matthew
AU - Manzardo, Christian
AU - McGowan, Catherine
AU - Meyer, Laurence
AU - Moore, Richard
AU - Mussini, Cristina
AU - Nakigoz, Gertrude
AU - Nash, Denis
AU - tek Ng, Oon
AU - Obel, Niels
AU - Pantazis, Nikos
AU - Poda, Armel
AU - Raben, Dorthe
AU - Reiss, Peter
AU - Riggen, Larry
AU - Sabin, Caroline
AU - d'Amour Sinayobye, Jean
AU - Sönnerborg, Anders
AU - Stoeckle, Marcel
AU - Thorne, Claire
AU - Torti, Carlo
PY - 2018
Y1 - 2018
N2 - Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively). We included HIV-infected individuals aged ≥16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-effect models were used to smooth trends in median CD4 cell counts. A total of 951855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/µL (95% confidence interval, 58-104/µL) to 287/µL (250-328/µL) in LICs, from 99/µL (71-140/µL) to 234/µL (192-285/µL) in LMICs, from 71/µL (49-104/µL) to 311/µL (255-379/µL) in UMICs, and from 161/µL (143-181/µL) to 327/µL (286-372/µL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional efforts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART
AB - Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively). We included HIV-infected individuals aged ≥16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-effect models were used to smooth trends in median CD4 cell counts. A total of 951855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/µL (95% confidence interval, 58-104/µL) to 287/µL (250-328/µL) in LICs, from 99/µL (71-140/µL) to 234/µL (192-285/µL) in LMICs, from 71/µL (49-104/µL) to 311/µL (255-379/µL) in UMICs, and from 161/µL (143-181/µL) to 327/µL (286-372/µL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional efforts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART
U2 - https://doi.org/10.1093/cid/cix915
DO - https://doi.org/10.1093/cid/cix915
M3 - Article
C2 - 29373672
SN - 1058-4838
VL - 66
SP - 893
EP - 903
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -