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CD4 count at antiretroviral therapy initiation and the risk of loss to follow-up: results from a multicentre cohort study
被引:30
作者:
Grimsrud, Anna
[1
]
Cornell, Morna
[1
,2
]
Schomaker, Michael
[2
]
Fox, Matthew P.
[3
,4
,5
]
Orrell, Catherine
[6
]
Prozesky, Hans
[7
,8
]
Stinson, Kathryn
[2
,9
]
Tanser, Frank
[10
]
Egger, Matthias
[11
]
Myer, Landon
[1
,2
]
机构:
[1] Univ Cape Town, Sch Publ Hlth & Family Med, Div Epidemiol & Biostat, Anzio Rd, ZA-7925 Cape Town, South Africa
[2] Univ Cape Town, Sch Publ Hlth & Family Med, Ctr Infect Dis Epidemiol & Res, ZA-7925 Cape Town, South Africa
[3] Boston Univ, Ctr Global Hlth & Dev, Boston, MA 02215 USA
[4] Univ Witwatersrand, Sch Clin Med, Fac Hlth Sci, Dept Internal Med,Hlth Econ & Epidemiol Res Off, Johannesburg, South Africa
[5] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
[6] Univ Cape Town, Inst Infect Dis & Mol Med, Desmond Tutu HIV Ctr, Fac Hlth Sci, ZA-7925 Cape Town, South Africa
[7] Univ Stellenbosch, Dept Med, Div Infect Dis, Cape Town, South Africa
[8] Tygerberg Acad Hosp, Cape Town, South Africa
[9] Med Sans Frontieres, Cape Town, South Africa
[10] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Mtubatuba, South Africa
[11] Univ Bern, ISPM, Div Int & Environm Hlth, Bern, Switzerland
基金:
加拿大健康研究院;
关键词:
SOUTH-AFRICA;
MORTALITY;
PROGRAMS;
OUTCOMES;
IEDEA;
AIDS;
D O I:
10.1136/jech-2015-206629
中图分类号:
R1 [预防医学、卫生学];
学科分类号:
1004 ;
120402 ;
摘要:
Background Antiretroviral therapy (ART) initiation is now recommended irrespective of CD4 count. However data on the relationship between CD4 count at ART initiation and loss to follow-up (LTFU) are limited and conflicting. Methods We conducted a cohort analysis including all adults initiating ART (2008-2012) at three public sector sites in South Africa. LTFU was defined as no visit in the 6 months before database closure. The Kaplan-Meier estimator and Cox's proportional hazards models examined the relationship between CD4 count at ART initiation and 24-month LTFU. Final models were adjusted for demographics, year of ART initiation, programme expansion and corrected for unascertained mortality. Results Among 17 038 patients, the median CD4 at initiation increased from 119 (IQR 54-180) in 2008 to 257 (IQR 175-318) in 2012. In unadjusted models, observed LTFU was associated with both CD4 counts <100 cells/mu L and CD4 counts >= 300 cells/mu L. After adjustment, patients with CD4 counts >= 300 cells/mu L were 1.35 (95% CI 1.12 to 1.63) times as likely to be LTFU after 24 months compared to those with a CD4 150-199 cells/mu L. This increased risk for patients with CD4 counts >= 300 cells/mu L was largest in the first 3 months on treatment. Correction for unascertained deaths attenuated the association between CD4 counts <100 cells/mu L and LTFU while the association between CD4 counts >= 300 cells/mu L and LTFU persisted. Conclusions Patients initiating ART at higher CD4 counts may be at increased risk for LTFU. With programmes initiating patients at higher CD4 counts, models of ART delivery need to be reoriented to support long-term retention.
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页码:549 / 555
页数:7
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