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




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* Corresponding author 1 Desmond Tutu HIV Centre 2 Mailman School of Public Health

Abstract : BACKGROUND: Few data are available on the long-term immunologic response to antiretroviral therapy ART in resource-limited settings, where ART is being rapidly scaled up using a public health approach, with a limited repertoire of drugs. OBJECTIVES: To describe immunologic response to ART among ART patients in a network of cohorts from sub-Saharan Africa, Latin America, and Asia. STUDY POPULATION-METHODS: Treatment-naive patients aged 15 and older from 27 treatment programs were eligible. Multilevel, linear mixed models were used to assess associations between predictor variables and CD4 cell count trajectories following ART initiation. RESULTS: Of 29 175 patients initiating ART, 8933 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 cell count measurements. The median baseline CD4 cell count was 114 cells-microl, with 35% having less than 100 cells-microl. Substantial intersite variation in baseline CD4 cell count was observed range 61-181 cells-microl. Women had higher median baseline CD4 cell counts than men 121 vs. 104 cells-microl. The median CD4 cell count increased from 114 cells-microl at ART initiation to 230 interquartile range 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 cell count was the most important determinant of subsequent CD4 cell count trajectories. CONCLUSION: 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.

Keywords : antiretroviral therapy CD4 response CD4 lymphocyte count low-income countries baseline CD4 count ART-LINC IeDEA





Author: Denis Nash - Monica Katyal - Martin Brinkhof - Olivia Keiser - Margaret May - Rachael Hughes - Francois Dabis - Robin Wood - Edua

Source: https://hal.archives-ouvertes.fr/



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