Article
Immunodeficiency at the start of combination antiretroviral therapy in low-, middle- and high-income countries
Registro en:
AVILA, Dorita et al. Immunodeficiency at the start of combination antiretroviral therapy in low-, middle- and high-income countries. Journal of acquired immune deficiency syndromes, v.65, n.1, p.1–19, 2014.
1525-4135
10.1097/QAI.0b013e3182a39979
1944-7884
Autor
Avila, Dorita
Althoff, Keri N
Mugglin, Catrina
Kaloustian, Kara Wools-
Koller, Manuel
Dabis, François
Nash, Denis
Gsponer, Thomas
Sungkanuparph, Somnuek
McGowan, Catherine
May, Margaret
Cooper, David
Chimbetete, Cleophas
Wolff, Marcelo
Collier, Ann
McManus, Hamish
Davies, Mary-Ann
Dominique, Costagliola
Ramírez, Brenda Crabtree
Chaiwarith, Romanee
Cescon, Angela
Cornell, Morna
Diero, Lameck
Phanuphak, Praphan
Sawadogo, Adrien
Ehmer, Jochen
Eholié, Serge Paul
Li, Patrick CK
Fox, Matthew P.
Ghandi, Neel E.
González, Elsa
Lee, Christopher KC
Hoffmann, Christopher J.
Kambugum, Andrew
Keiser, Olivia
Ditangco, Rossana
Prozesky, Hans
Lampe, Fiona
Kumarasamy, Nagalingeswaran
Kitahata, Mari
Lugina, Emmanuel
Lyamuya, Rita
Vonthanak, Saphonn
Fink, Valeria
Monforte, Antonella d’Arminio
Luz, Paula Mendes
Chen, Yi-Ming Arthur
Minga, Albert
Casabona, Jordi
Mwango, Albert
Choi, Jun Y.
Newell, Marie-Louise
Bukusi, Elizabeth A.
Ngonyani, Kapella
Merati, Tuti P.
Otieno, Juliana
Bosco, Mwebesa B.
Phiri, Sam
Ng, Oon T.
Anastos, Kathryn
Rockstroh, Jürgen
Santos, Ignacio
Oka, Shinichi
Somi, Geoffrey
Stephan, Christoph
Teira, Ramon
Wabwire, Deo
Wandeler, Gilles
Boulle, Andrew
Reiss, Peter
Wood, Robin
Chi, Benjamin H.
Williams, Carolyn
Sterne, Jonathan A.
Egger, Matthias
Resumen
Objective: To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries.
Methods: Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed.
Results: In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): −56 to +30] lower in LMIC, 22 cells/μL (−62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage.
Conclusions: Median CD4 cell counts at the start of cART increased 2000–2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.