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

The IeDEA and COHERE Cohort Collaborations

doi:10.1093/cid/cix915

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

The IeDEA and COHERE Cohort Collaborations

HIV & Aids Reporting

Research output: Contribution to journal › Article › peer-review

83 Citations (Scopus)

Abstract

Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. We included HIV-infected individuals aged =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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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/μL (95% confdence interval, 58-104/μL) to 287/μL (250-328/μL) in LICs, from 99/μL (71-140/μL) to 234/μL (192-285/μL) in LMICs, from 71/μL (49-104/μL) to 311/μL (255-379/μL) in UMICs, and from 161/μL (143-181/μL) to 327/μL (286-372/μL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

Original language	English
Pages (from-to)	893-903
Number of pages	11
Journal	Clinical Infectious Diseases
Volume	66
Issue number	6
DOIs	https://doi.org/10.1093/cid/cix915
Publication status	Published - 5 Mar 2018

Bibliographical note

Funding Information:
Financial support. The African regions for IeDEA are supported by the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Allergy and Infectious Diseases (NIAID) as part of the IeDEA (grants U01AI069919, U01AI069924, U01AI096299, and U01AI069911). The Caribbean, Central, and South America Network for HIV Epidemiology (CCASAnet), a member cohort of IeDEA (grant U01AI069923), is funded by the following institutes: NICHD, Office of the Director, NIH, NIAID, the National Cancer Institute, and the National Institute of Mental Health. The North American AIDS Cohort Collaboration on Research and Design of IeDEA is supported by the NIH (grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01AG053100, R01CA165937, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176); the US Centers for Disease Control and Prevention (CDC; contracts CDC-200-2006-18797 and CDC-200-2015-63931); from the US Agency for Healthcare Research and Quality (contract 90047713); from the US Health Resources and Services Administration (contract 90051652); the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. The TREAT Asia HIV Observational Database and the Australian HIV Observational Database are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the NIAID, the NICHD, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of IeDEA (grant U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and affiliated with the Faculty of Medicine, UNSW Sydney.

Publisher Copyright:
© 2017 The Author(s).

Keywords

CD4 cell count
WHO guidelines
antiretroviral therapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/cid/cix915

Cite this

@article{2417f23dd02748818bbd48338be803e8,

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

abstract = "Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. We included HIV-infected individuals aged =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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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/μL (95% confdence interval, 58-104/μL) to 287/μL (250-328/μL) in LICs, from 99/μL (71-140/μL) to 234/μL (192-285/μL) in LMICs, from 71/μL (49-104/μL) to 311/μL (255-379/μL) in UMICs, and from 161/μL (143-181/μL) to 327/μL (286-372/μL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.",

keywords = "CD4 cell count, WHO guidelines, antiretroviral therapy",

author = "{The IeDEA and COHERE Cohort Collaborations} and Nanina Anderegg and Klea Panayidou and Yao Abo and Belen Alejos and Althoff, {Keri N.} and Kathryn Anastos and Andrea Antinori and Eric Balestre and Renaud Becquet and Antonella Castagna and Barbara Castelnuovo and Genevi{\`e}ve Ch{\^e}ne and Lara Coelho and Collins, {Intira Jeannie} and Dominique Costagliola and Brenda Crabtree-Ram{\'i}rez and Francois Dabis and {D{\textquoteright}Arminio Monforte}, Antonella and Davies, {Mary Ann} and {De Wit}, St{\'e}phane and Val{\'e}rie Delpech and {De La Mata}, {Nicole L.} and Stephany Duda and Aimee Freeman and Gange, {Stephen J.} and Katharina Grabmeier-Pfistershammer and Barbara Gunsenheimer-Bartmeyer and Awachana Jiamsakul and Kitahata, {Mari M.} and Matthew Law and Christian Manzardo and Catherine McGowan and Laurence Meyer and Richard Moore and Cristina Mussini and Gertrude Nakigoz and Denis Nash and Ng, {Oon Tek} and Niels Obel and Nikos Pantazis and Armel Poda and Dorthe Raben and Peter Reiss and Larry Riggen and Caroline Sabin and {D{\textquoteright}Amour Sinayobye}, Jean and Anders S{\"o}nnerborg and Marcel Stoeckle and Claire Thorne and Carlo Torti",

note = "Funding Information: Financial support. The African regions for IeDEA are supported by the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Allergy and Infectious Diseases (NIAID) as part of the IeDEA (grants U01AI069919, U01AI069924, U01AI096299, and U01AI069911). The Caribbean, Central, and South America Network for HIV Epidemiology (CCASAnet), a member cohort of IeDEA (grant U01AI069923), is funded by the following institutes: NICHD, Office of the Director, NIH, NIAID, the National Cancer Institute, and the National Institute of Mental Health. The North American AIDS Cohort Collaboration on Research and Design of IeDEA is supported by the NIH (grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01AG053100, R01CA165937, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176); the US Centers for Disease Control and Prevention (CDC; contracts CDC-200-2006-18797 and CDC-200-2015-63931); from the US Agency for Healthcare Research and Quality (contract 90047713); from the US Health Resources and Services Administration (contract 90051652); the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. The TREAT Asia HIV Observational Database and the Australian HIV Observational Database are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the NIAID, the NICHD, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of IeDEA (grant U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and affiliated with the Faculty of Medicine, UNSW Sydney. Publisher Copyright: {\textcopyright} 2017 The Author(s).",

year = "2018",

month = mar,

day = "5",

doi = "10.1093/cid/cix915",

language = "English",

volume = "66",

pages = "893--903",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "6",

}

TY - JOUR

T1 - Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy

T2 - Collaborative Study of Treatment Programs

AU - The IeDEA and COHERE Cohort Collaborations

AU - Anderegg, Nanina

AU - Panayidou, Klea

AU - Abo, Yao

AU - Alejos, Belen

AU - Althoff, Keri N.

AU - Anastos, Kathryn

AU - Antinori, Andrea

AU - Balestre, Eric

AU - Becquet, Renaud

AU - Castagna, Antonella

AU - Castelnuovo, Barbara

AU - Chêne, Geneviève

AU - Coelho, Lara

AU - Collins, Intira Jeannie

AU - Costagliola, Dominique

AU - Crabtree-Ramírez, Brenda

AU - Dabis, Francois

AU - D’Arminio Monforte, Antonella

AU - Davies, Mary Ann

AU - De Wit, Stéphane

AU - Delpech, Valérie

AU - De La Mata, Nicole L.

AU - Duda, Stephany

AU - Freeman, Aimee

AU - Gange, Stephen J.

AU - Grabmeier-Pfistershammer, Katharina

AU - Gunsenheimer-Bartmeyer, Barbara

AU - Jiamsakul, Awachana

AU - Kitahata, Mari M.

AU - Law, Matthew

AU - Manzardo, Christian

AU - McGowan, Catherine

AU - Meyer, Laurence

AU - Moore, Richard

AU - Mussini, Cristina

AU - Nakigoz, Gertrude

AU - Nash, Denis

AU - Ng, Oon Tek

AU - Obel, Niels

AU - Pantazis, Nikos

AU - Poda, Armel

AU - Raben, Dorthe

AU - Reiss, Peter

AU - Riggen, Larry

AU - Sabin, Caroline

AU - D’Amour Sinayobye, Jean

AU - Sönnerborg, Anders

AU - Stoeckle, Marcel

AU - Thorne, Claire

AU - Torti, Carlo

N1 - Funding Information: Financial support. The African regions for IeDEA are supported by the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Allergy and Infectious Diseases (NIAID) as part of the IeDEA (grants U01AI069919, U01AI069924, U01AI096299, and U01AI069911). The Caribbean, Central, and South America Network for HIV Epidemiology (CCASAnet), a member cohort of IeDEA (grant U01AI069923), is funded by the following institutes: NICHD, Office of the Director, NIH, NIAID, the National Cancer Institute, and the National Institute of Mental Health. The North American AIDS Cohort Collaboration on Research and Design of IeDEA is supported by the NIH (grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01AG053100, R01CA165937, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176); the US Centers for Disease Control and Prevention (CDC; contracts CDC-200-2006-18797 and CDC-200-2015-63931); from the US Agency for Healthcare Research and Quality (contract 90047713); from the US Health Resources and Services Administration (contract 90051652); the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. The TREAT Asia HIV Observational Database and the Australian HIV Observational Database are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the NIAID, the NICHD, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of IeDEA (grant U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and affiliated with the Faculty of Medicine, UNSW Sydney. Publisher Copyright: © 2017 The Author(s).

PY - 2018/3/5

Y1 - 2018/3/5

N2 - Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. We included HIV-infected individuals aged =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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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/μL (95% confdence interval, 58-104/μL) to 287/μL (250-328/μL) in LICs, from 99/μL (71-140/μL) to 234/μL (192-285/μL) in LMICs, from 71/μL (49-104/μL) to 311/μL (255-379/μL) in UMICs, and from 161/μL (143-181/μL) to 327/μL (286-372/μL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

AB - Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency 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). Methods. We included HIV-infected individuals aged =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-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 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/μL (95% confdence interval, 58-104/μL) to 287/μL (250-328/μL) in LICs, from 99/μL (71-140/μL) to 234/μL (192-285/μL) in LMICs, from 71/μL (49-104/μL) to 311/μL (255-379/μL) in UMICs, and from 161/μL (143-181/μL) to 327/μL (286-372/μL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

KW - CD4 cell count

KW - WHO guidelines

KW - antiretroviral therapy

UR - http://www.scopus.com/inward/record.url?scp=85043386739&partnerID=8YFLogxK

U2 - 10.1093/cid/cix915

DO - 10.1093/cid/cix915

M3 - Article

C2 - 29373672

AN - SCOPUS:85043386739

SN - 1058-4838

VL - 66

SP - 893

EP - 903

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 6

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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