Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs

The IeDEA and COHERE Cohort Collaborations

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. 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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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% confdence 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. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

Original languageEnglish (US)
Pages (from-to)893-903
Number of pages11
JournalClinical Infectious Diseases
Volume66
Issue number6
DOIs
StatePublished - Mar 5 2018

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CD4 Lymphocyte Count
Viruses
Therapeutics
Disease Progression
Early Diagnosis
Acquired Immunodeficiency Syndrome
Epidemiology
Databases
Research

Keywords

  • antiretroviral therapy
  • CD4 cell count
  • WHO guidelines

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy : Collaborative Study of Treatment Programs. / The IeDEA and COHERE Cohort Collaborations.

In: Clinical Infectious Diseases, Vol. 66, No. 6, 05.03.2018, p. 893-903.

Research output: Contribution to journalArticle

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title = "Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs",
abstract = "Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. 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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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{\%} confdence 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. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.",
keywords = "antiretroviral therapy, CD4 cell count, WHO guidelines",
author = "{The IeDEA and COHERE Cohort Collaborations} and Nanina Anderegg and Klea Panayidou and Yao Abo and Belen Alejos and Althoff, {Keri N.} and Kathryn Anastos and Andrea Antinori and Eric Balestre and Renaud Becquet and Antonella Castagna and Barbara Castelnuovo and Genevi{\`e}ve Ch{\^e}ne and Lara Coelho and Collins, {Intira Jeannie} and Dominique Costagliola and Brenda Crabtree-Ram{\'i}rez and Francois Dabis and {D’Arminio Monforte}, Antonella and Davies, {Mary Ann} and {De Wit}, St{\'e}phane and Val{\'e}rie Delpech and {De La Mata}, {Nicole L.} and Stephany Duda and Aimee Freeman and Gange, {Stephen J.} and Katharina Grabmeier-Pfistershammer and Barbara Gunsenheimer-Bartmeyer and Awachana Jiamsakul and Kitahata, {Mari M.} and Matthew Law and Christian Manzardo and Catherine McGowan and Laurence Meyer and Richard Moore and Cristina Mussini and Gertrude Nakigoz and Denis Nash and Ng, {Oon Tek} and Niels Obel and Nikos Pantazis and Armel Poda and Dorthe Raben and Peter Reiss and Larry Riggen and Caroline Sabin and {D’Amour Sinayobye}, Jean and Anders S{\"o}nnerborg and Marcel Stoeckle and Claire Thorne and Kara Wools-Kaloustian",
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TY - JOUR

T1 - Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy

T2 - Collaborative Study of Treatment Programs

AU - The IeDEA and COHERE Cohort Collaborations

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 - Ng, Oon Tek

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 - Wools-Kaloustian, Kara

PY - 2018/3/5

Y1 - 2018/3/5

N2 - Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. 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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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% confdence 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. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

AB - Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. 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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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% confdence 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. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

KW - antiretroviral therapy

KW - CD4 cell count

KW - WHO guidelines

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U2 - 10.1093/cid/cix915

DO - 10.1093/cid/cix915

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AN - SCOPUS:85043386739

VL - 66

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