Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries

Avila, Dorita; Althoff, Keri N.; Mugglin, Catrina; Wools-Kaloustian, Kara; Koller, Manuel; Dabis, François; Nash, Denis; Gsponer, Thomas; Sungkanuparph, Somnuek; McGowan, Catherine; May, Margaret; Cooper, David; Chimbetete, Cleophas; Wolff, Marcelo; Collier, Ann; McManus, Hamish; Davies, Mary-Ann; Costagliola, Dominique; Crabtree-Ramirez, Brenda; Chaiwarith, Romanee; ... (2014). Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. Journal of acquired immune deficiency syndromes JAIDS, 65(1), e8-16. Lippincott Williams & Wilkins 10.1097/QAI.0b013e3182a39979

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OBJECTIVE To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. METHODS Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. RESULTS In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): -56 to +30] lower in LMIC, 22 cells/μL (-62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage. CONCLUSIONS Median CD4 cell counts at the start of cART increased 2000-2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Avila Rojas, Dorita; Mugglin, Catrina; Gsponer, Thomas; Keiser, Olivia; Wandeler, Gilles and 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:

Users 22 not found.

Date Deposited:

21 Mar 2014 08:57

Last Modified:

23 Oct 2015 07:19

Publisher DOI:

10.1097/QAI.0b013e3182a39979

PubMed ID:

24419071

BORIS DOI:

10.7892/boris.47231

URI:

https://boris.unibe.ch/id/eprint/47231

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