Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda

Simple item page
dc.contributor.authorBray, Sarah
dc.contributor.authorGedeon, Jillian
dc.contributor.authorHadi, Ahsan ard J Mills
dc.contributor.authorKotb, Ahmed
dc.contributor.authorRahman, Tarun
dc.contributor.authorSarwar, Elaha
dc.contributor.authorSavelyeva, Anna
dc.contributor.authorSévigny, Marika
dc.contributor.authorBakanda, Celestin
dc.contributor.authorBirungi, Josephine
dc.contributor.authorChan, Keith
dc.contributor.authorYaya, Sanni
dc.contributor.authorDeonandan, Raywat
dc.contributor.authorMills, Edward J.
dc.date.accessioned2022-02-04T11:42:37Z
dc.date.available2022-02-04T11:42:37Z
dc.date.issued2012
dc.description.abstractAlthough international guidelines recommend initiating antiretroviral therapy (ART) when a patient’s CD4 cell count is #350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda. Design: This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda. Methods: We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (,50, 50–99, 100–149, 150–249, 250+ cells/μL). We constructed Kaplan–Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up. Results: Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150–249, hazard ratio [HR] 0.60, 95% confidence interval [CI]: 0.45–0.82, P = 0.001; 250+, HR 0.66, 95% CI, 0.44–1.00, P = −0.05). Male sex, older age, and duration of time on ART were independently associated with mortality. When left-censoring at 2 years, CD4 nadir was no longer statistically significantly associated with mortality. Conclusion: After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda. This should argue for efforts to increase engagement with patients to ensure a higher CD4 nadir at initiation of treatment.en_US
dc.identifier.citationBray, S., Gedeon, J., Hadi, A., Kotb, A., Rahman, T., Sarwar, E., ... & Mills, E. J. (2012). Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda. HIV/AIDS (Auckland, NZ), 4, 135. http://dx.doi.org/10.2147/HIV.S35374en_US
dc.identifier.urihttp://dx.doi.org/10.2147/HIV.S35374
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1883
dc.language.isoenen_US
dc.publisherHIV/AIDS – Research and Palliative Careen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectARTen_US
dc.subjectCD4en_US
dc.subjectPrognosisen_US
dc.subjectSub-Saharan Africaen_US
dc.titlePredictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Ugandaen_US
dc.typeArticleen_US
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Predictive value of CD4 cell count nadir.pdf
Size:
744.59 KB
Format:
Adobe Portable Document Format
Description:
Article
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Medical and Health Sciences