CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa

Hoffmann, Christopher J.; Schomaker, Michael; Fox, Matthew P.; Mutevedzi, Portia; Giddy, Janet; Prozesky, Hans; Wood, Robin; Garone, Daniela B.; Egger, Matthias; Boulle, Andrew (2013). CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa. Journal of acquired immune deficiency syndromes JAIDS, 63(1), pp. 34-41. Philadelphia, Pa.: Lippincott Williams & Wilkins 10.1097/QAI.0b013e318287c1fe

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BACKGROUND In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information. METHODS We analyzed data from a large multicohort study in South Africa, where HIV RNA is routinely monitored. Adult HIV-positive patients initiating cART between 2003 and 2010 were included. Mortality was analyzed in Cox models; CD4 count slope by HIV RNA level was assessed using linear mixed models. RESULTS About 44,829 patients (median age: 35 years, 58% female, median CD4 count at cART initiation: 116 cells/mm) were followed up for a median of 1.9 years, with 3706 deaths. Mean CD4 count slopes per week ranged from 1.4 [95% confidence interval (CI): 1.2 to 1.6] cells per cubic millimeter when HIV RNA was <400 copies per milliliter to -0.32 (95% CI: -0.47 to -0.18) cells per cubic millimeter with >100,000 copies per milliliter. The association of CD4 slope with mortality depended on current CD4 count: the adjusted hazard ratio (aHRs) comparing a >25% increase over 6 months with a >25% decrease was 0.68 (95% CI: 0.58 to 0.79) at <100 cells per cubic millimeter but 1.11 (95% CI: 0.78 to 1.58) at 201-350 cells per cubic millimeter. In contrast, the aHR for current CD4 count, comparing >350 with <100 cells per cubic millimeter, was 0.10 (95% CI: 0.05 to 0.20). CONCLUSIONS Absolute CD4 count remains a strong risk for mortality with a stable effect size over the first 4 years of cART. However, CD4 count slope and HIV RNA provide independently added to the model.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Egger, Matthias

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0894-9255

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

15 Jan 2014 10:26

Last Modified:

30 Dec 2014 01:21

Publisher DOI:

10.1097/QAI.0b013e318287c1fe

PubMed ID:

23344547

Uncontrolled Keywords:

HIV, resource-limited setting, CD4 count slope, mortality, HIV RNA, antiretroviral therapy

BORIS DOI:

10.7892/boris.39058

URI:

https://boris.unibe.ch/id/eprint/39058

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