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

被引：99

作者：

Anderegg, Nanina ^{[1
]}

Panayidou, Klea ^{[1
]}

Abo, Yao ^{[2
]}

Alejos, Belen ^{[3
]}

Althoff, Keri N. ^{[4
]}

Anastos, Kathryn ^{[5
,6
]}

Antinori, Andrea ^{[7
]}

Balestre, Eric ^{[8
]}

Becquet, Renaud ^{[9
,10
]}

Castagna, Antonella ^{[11
]}

Castelnuovo, Barbara ^{[12
]}

Chene, Genevieve ^{[13
]}

Coelho, Lara ^{[14
]}

Collins, Intira Jeannie ^{[15
]}

Costagliola, Dominique ^{[16
]}

Crabtree-Ramirez, Brenda ^{[17
]}

Dabis, Francois ^{[18
,19
]}

Monforte, Antonella d'Arminio ^{[20
]}

Davies, Mary-Ann ^{[21
]}

De Wit, Stephane ^{[22
]}

Delpech, Valerie ^{[23
]}

De La Mata, Nicole L. ^{[24
]}

Duda, Stephany ^{[25
]}

Freeman, Aimee ^{[4
]}

Gange, Stephen J. ^{[4
]}

Grabmeier-Pfistershammer, Katharina ^{[26
]}

Gunsenheimer-Bartmeyer, Barbara ^{[27
]}

Jiamsakul, Awachana ^{[24
]}

Kitahata, Mari M. ^{[28
]}

Law, Matthew

Manzardo, Christian ^{[29
]}

McGowan, Catherine ^{[30
]}

Meyer, Laurence ^{[31
]}

Moore, Richard ^{[32
]}

Mussini, Cristina ^{[33
]}

Nakigoz, Gertrude ^{[34
]}

Nash, Denis ^{[35
,36
]}

Ng, Oon Tek ^{[37
]}

Obel, Niels ^{[38
]}

Pantazis, Nikos ^{[39
]}

Poda, Armel ^{[40
]}

Raben, Dorthe ^{[38
]}

Reiss, Peter ^{[41
,42
,43
]}

Riggen, Larry ^{[44
]}

Sabin, Caroline ^{[45
]}

Sinayobye, Jean d'Amour ^{[46
]}

Sonnerborg, Anders ^{[47
,48
]}

Stoeckle, Marcel ^{[49
,50
]}

Thorne, Claire ^{[51
]}

Torti, Carlo ^{[52
]}

机构：

[1] Univ Bern, Inst Social & Prevent Med, Finkenhubelweg 11, CH-3012 Bern, Switzerland

[2] Ctr Hosp Univ Treichville, Programme PAC CI, Abidjan, Cote Ivoire

[3] Inst Salud Carlos III, Natl Ctr Epidemiol, Madrid, Spain

[4] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[5] Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA

[6] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, Bronx, NY 10467 USA

[7] IRCCS, Natl Inst Infect Dis L Spallanzani, HIV AIDS Dept, Rome, Italy

[8] Univ Bordeaux, Bordeaux Populat Hlth, Ctr INSERM U1219, Bordeaux, France

[9] Univ Bordeaux, INSERM, Ctr Rech, U1219, Bordeaux, France

[10] Univ Bordeaux, Inst Sante Publ Epidemiol Dev, Bordeaux, France

[11] Univ Vita Salute San Raffaele, Dept Infect Dis, San Raffaele Sci Inst, Milan, Italy

[12] Makerere Univ, Infect Dis Inst, Mulago Hosp, Kampala, Uganda

[13] INSERM, ISPED, Ctr INSERM, U1219 Bordeaux Populat Hlth, Bordeaux, France

[14] Fundacao Oswaldo Cruz, Inst Pesquisa Clin Evandro Chagas, Rio De Janeiro, Brazil

[15] UCL, Inst Clin Trials & Methodol, MRC, Clin Trials Unit, London, England

[16] Univ Paris 06, UPMC, Sorbonne Univ, INSERM,Inst Pierre Louis Epidemiol & Sante Publ, Paris, France

[17] Inst Nacl Ciencias Med Nutr Salvador Zubiran, Dept Infect Dis, Mexico City, DF, Mexico

[18] Univ Bordeaux, INSERM, Ctr Rech, INSERM,U1219, Bordeaux, France

[19] Univ Bordeaux, Inst Sante Publ Epidemiol Dev, Bordeaux, France

[20] Univ Milan, Dept Hlth Sci, Clin Infect & Trop Dis, ASST Santi Paolo & Carlo, Milan, Italy

[21] Univ Cape Town, Sch Publ Hlth & Family Med, Ctr Infect Dis Epidemiol & Res, Cape Town, South Africa

[22] Univ Libre Bruxelles, St Pierre Univ Hosp, Dept Infect Dis, Brussels, Belgium

[23] Publ Hlth England, London, England

[24] UNSW Sydney, Kirby Inst, Sydney, NSW, Australia

[25] Vanderbilt Univ, Med Ctr, Dept Biomed Informat, Nashville, TN USA

[26] Med Univ Vienna, Div Immunol Allergy & Infect Dis, Vienna, Austria

[27] Robert Koch Inst, Berlin, Germany

[28] Univ Washington, Ctr AIDS Res, Seattle, WA 98195 USA

[29] Univ Barcelona, Hosp Clin IDIBAPS, Infect Dis Serv, Barcelona, Spain

[30] Vanderbilt Univ, Med Ctr, Div Infect Dis, 221 Kirkland Hall, Nashville, TN 37235 USA

[31] Univ Paris Sud, Le Kremlin Bicetre, France

[32] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Med, Baltimore, MD USA

[33] Univ Modena & Reggio Emilia, Clin Infect Dis, Modena, Italy

[34] Rakai Hlth Sci Program, Kalisizo, Uganda

[35] CUNY, Inst Implementat Sci Populat Hlth, New York, NY USA

[36] CUNY, Grad Sch Publ Hlth & Hlth Policy, New York, NY USA

[37] Tan Tock Seng Hosp, Singapore, Singapore

[38] Univ Copenhagen, Dept Infect Dis, Rigshosp, Copenhagen, Denmark

[39] Natl & Kapodistrian Univ Athens, Med Sch, Dept Hyg Epidemiol & Med Stat, Athens, Greece

[40] Univ Polytech Bobo Dioulasso, Inst Super Sci Sante, Bobo Dioulasso, Burkina Faso

[41] Univ Amsterdam, Acad Med Ctr, Stichting HIV Monitoring, Amsterdam, Netherlands

[42] Univ Amsterdam, Dept Global Hlth, Acad Med Ctr, Amsterdam, Netherlands

[43] Univ Amsterdam, Div Infect Dis, Acad Med Ctr, Amsterdam, Netherlands

[44] Indiana Univ, Fairbanks Sch Publ Hlth, Dept Biostat, Indianapolis, IN USA

[45] UCL, Res Dept Infect & Populat Hlth, London, England

[46] Rwanda Mil Hosp, Div Res & Clin Educ, Kanombe, Kigali, Rwanda

[47] Karolinska Inst, Stockholm, Sweden

[48] Karolinska Univ Hosp, Stockholm, Sweden

[49] Univ Basel Hosp, Div Infect Dis & Hosp Epidemiol, Basel, Switzerland

[50] Univ Basel, Basel, Switzerland

来源：

CLINICAL INFECTIOUS DISEASES | 2018年 / 66卷 / 06期

基金：

加拿大健康研究院; 英国医学研究理事会; 美国医疗保健研究与质量局;

关键词：

antiretroviral therapy; CD4 cell count; WHO guidelines; INTERNATIONAL EPIDEMIOLOGIC DATABASES; ADVANCED HIV DISEASE; EVALUATE AIDS IEDEA; COHORT PROFILE; INITIATION; CARE; GUIDELINES;

D O I：

10.1093/cid/cix915

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

We modeled global time trends in median CD4 cell counts at combination antiretroviral therapy initiation in human immunodeficiency virus-infected adults. These counts have increased in all country income groups since 2002 but generally remained below 350/mu L in 2015.Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency 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). We included HIV-infected individuals aged a parts per thousand<yen>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-effect models were used to smooth trends in median CD4 cell counts. A total of 951855 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/A mu L (95% confidence interval, 58-104/A mu L) to 287/A mu L (250-328/A mu L) in LICs, from 99/A mu L (71-140/A mu L) to 234/A mu L (192-285/A mu L) in LMICs, from 71/A mu L (49-104/A mu L) to 311/A mu L (255-379/A mu L) in UMICs, and from 161/A mu L (143-181/A mu L) to 327/A mu L (286-372/A mu L) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/mu L in 2015. Substantial additional efforts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

引用

页码：893 / 903

页数：11

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