The prognostic value of baseline CD4R cell count beyond 6 months of antiretroviral therapy in HIV-positive patients in a resource-limited setting
Loading...
Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
Aids
Abstract
The risk of death is highest in the first few months after initiation of
antiretroviral therapy (ART). We examined whether initial CD4þ cell count maintains
a strong prognostic value among patients with at least 6 months follow-up after the
initiation of ART.
Design: Observational study of HIV patients in Uganda aged 14 years or older enrolled
in 10 clinics across Uganda.
Methods: Baseline CD4þ cell count of patients with more than 6 months of follow-up
were stratified into categories (<50, 50–99, 100–149, 150–249, >250 cells/ml). A
Kaplan–Meier survival analysis and Cox proportional hazards regression was used to
model the associations between baseline CD4þ cell count and mortality.
Results: Of 22 315 patients, 20 730 (92.8%) had more than 6 months of follow-up. Six
hundred and eleven (2.9%) patients died during follow-up and 737 (3.6%) were lost to
follow-up. Relative to a baseline CD4þ cell counts of less than 50 cells/ml, the adjusted
hazard ratios for death were 0.83 [95% confidence interval (CI) 0.67–1.02], 0.71 (95%
CI 0.57–0.88), 0.52 (95% CI 0.42–0.64), and 0.55 (95% CI 0.42–0.70) favouring those
with baseline CD4þ cell counts of 50–99, 100–149, 150–249, and at least 250 cells/ml,
respectively. Differing ages and male sex increased the likelihood of mortality.
Conclusion: Among patients with more than 6 months of follow-up after initiation of
ART, baseline CD4þ cell count at initiation still has important prognostic value. This
suggests that active engagement and earlier treatment initiation is important for longterm
survival.
Description
Keywords
Antiretroviral therapy, CD4þ, HIV, Prognosis, Uganda, Sub-Saharan Africa
Citation
Mills, E. J., Bakanda, C., Birungi, J., Yaya, S., & Ford, N. (2012). The prognostic value of baseline CD4+ cell count beyond 6 months of antiretroviral therapy in HIV-positive patients in a resource-limited setting. Aids, 26(11), 1425-1429. DOI:10.1097/QAD.0b013e328354bf43