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.
引用
收藏
页码:549 / 555
页数:7
相关论文
共 50 条
  • [21] Risk factors for loss to follow-up, transfer or death among people living with HIV on their first antiretroviral therapy regimen in Mali
    Balde, A.
    Lievre, L.
    Maiga, A. I.
    Diallo, F.
    Maiga, I. A.
    Costagliola, D.
    Abgrall, S.
    HIV MEDICINE, 2019, 20 (01) : 47 - 53
  • [22] Retention and Risk Factors for Loss to Follow-up of Female and Male Sex Workers on Antiretroviral Treatment in Ivory Coast: A Retrospective Cohort Analysis
    Vuylsteke, Bea
    Semde, Gisele
    Auld, Andrew F.
    Sabatier, Jennifer
    Kouakou, Joseph
    Ettiegne-Traore, Virginie
    Buve, Anne
    Laga, Marie
    JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2015, 68 : S99 - S106
  • [23] Estimating the Optimal CD4 Count for HIV-infected Persons to Start Antiretroviral Therapy
    Shepherd, Bryan E.
    Jenkins, Cathy A.
    Rebeiro, Peter F.
    Stinnette, Samuel E.
    Bebawy, Sally S.
    McGowan, Catherine C.
    Hulgan, Todd
    Sterling, Timothy R.
    EPIDEMIOLOGY, 2010, 21 (05) : 698 - 705
  • [24] Loss to follow-up of patients in HIV care in Burundi: A retrospective cohort study
    Nshimirimana, Clement
    Ndayizeye, Aime
    Smekens, Tom
    Vuylsteke, Bea
    TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2022, 27 (06) : 574 - 582
  • [25] Mortality, AIDS-Morbidity, and Loss to Follow-up by Current CD4 Cell Count Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in Africa and Asia: Data From the ANRS 12222 Collaboration
    Gabillard, Delphine
    Lewden, Charlotte
    Ndoye, Ibra
    Moh, Raoul
    Segeral, Olivier
    Tonwe-Gold, Besigin
    Etard, Jean-Francois
    Pagnaroat, Men
    Fournier-Nicolle, Isabelle
    Eholie, Serge
    Konate, Issouf
    Minga, Albert
    Mpoudi-Ngole, Eitel
    Koulla-Shiro, Sinata
    Zannou, Djimon Marcel
    Anglaret, Xavier
    Laurent, Christian
    JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2013, 62 (05) : 555 - 561
  • [26] CD4 Cell Count and the Risk of AIDS or Death in HIV-Infected Adults on Combination Antiretroviral Therapy with a Suppressed Viral Load: A Longitudinal Cohort Study from COHERE
    Young, Jim
    Psichogiou, Mina
    Meyer, Laurence
    Ayayi, Sylvie
    Grabar, Sophie
    Raffi, Francois
    Reiss, Peter
    Gazzard, Brian
    Sharland, Mike
    Gutierrez, Felix
    Obel, Niels
    Kirk, Ole
    Miro, Jose M.
    Furrer, Hansjakob
    Castagna, Antonella
    De Wit, Stephane
    Munoz, Josefa
    Kjaer, Jesper
    Colin, Celine
    Grarup, Jesper
    Chene, Genevieve
    Bucher, Heiner
    Furrer, Hansjakob
    Miro, Jose
    Zangerle, Robert
    Antoniadou, Anastasia
    Ghosn, Jade
    Morlat, Philippe
    Le Moing, Vincent
    Reiss, Peter
    Fisher, Martin
    Sharland, Mike
    Mocroft, Amanda
    Kirk, Ole
    Stephan, Christoph
    Girardi, Enrico
    Torti, Carlo
    Mussini, Cristina
    Galli, Laura
    Ledergerber, Bruno
    Teira, Ramon
    Zangerle, Robert
    Touloumi, Giota
    Warszawski, Josiane
    Meyer, Laurence
    Dabis, Francois
    Krause, Murielle Mary
    Ghosn, Jade
    Leport, Catherine
    de Wolf, Frank
    PLOS MEDICINE, 2012, 9 (03)
  • [27] IL-2 therapy: potential impact of the CD4 cell count at initiation on clinical efficacy-results from the ANRS CO4 cohort
    Fontas, Eric
    Kousignian, Isabelle
    Pradier, Christian
    Poizot-Martin, Isabelle
    Durier, Christine
    Weiss, Laurence
    Levy, Yves
    Costagliola, Dominique
    JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2010, 65 (10) : 2215 - 2223
  • [28] Risk Factors for Loss to Follow-up of Elderly Patients After Hip Fracture Surgery: A Retrospective Cohort Study
    Rui, Min
    Hui, Yujian
    Mao, Jiannan
    Ma, Tao
    Zheng, Xin
    GERIATRIC ORTHOPAEDIC SURGERY & REHABILITATION, 2024, 15
  • [29] Effect of baseline CD4 cell count at linkage to HIV care and at initiation of antiretroviral therapy on mortality in HIV-positive adult patients in Rwanda: a nationwide cohort study
    Nsanzimana, Sabin
    Remera, Eric
    Kanters, Steve
    Forrest, Jamie I.
    Ford, Nathan
    Condo, Jeanine
    Binagwaho, Agnes
    Bucher, Heiner
    Thorlund, Kristian
    Vitoria, Marco
    Mills, Edward J.
    LANCET HIV, 2015, 2 (09): : E376 - E384
  • [30] Mortality Among Adults Transferred and Lost to Follow-up From Antiretroviral Therapy Programmes in South Africa: A Multicenter Cohort Study
    Cornell, Morna
    Lessells, Richard
    Fox, Matthew P.
    Garone, Daniela B.
    Giddy, Janet
    Fenner, Lukas
    Myer, Landon
    Boulle, Andrew
    JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2014, 67 (02) : E67 - E75