Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Böck, Peter; James, Anelet; Nikuze, Alliance; Peton, Neshaan; Sabapathy, Kalpana; Mills, Edward J.; Fidler, Sarah; Ford, Nathan

doi:10.1097/qai.0000000000001092

Cited by 24 publications

(23 citation statements)

References 48 publications

(117 reference statements)

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“…Our cohort comprised individuals with a higher median CD4 count at ART initiation than in those studies and findings corroborate that seen in high income countries reported in the systematic review by Bock et al. . WHO recommends universal test and treat for HIV ; South Africa has already adopted this recommendation but there are no data on adherence in people initiating ART at high CD4 counts (CD4 > 350) in the African setting.…”

Section: Discussionsupporting

confidence: 85%

“…With the new treatment guidelines, the median CD4 count at which individuals initiate ART is likely to rise to levels observed in our cohort. However, a meta-analysis covering the period from January 2002 to Dec 2013 showed that the CD4 count at presentation for HIV care has increased in South Africa but the CD4 count at ART initiation has remained unchanged at a mean of 123 cells/mm 3 [18].…”

Section: Discussionmentioning

confidence: 99%

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Universal test and treat is not associated with sub‐optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial

Iwuji

McGrath

Calmy³

et al. 2018

J Intern AIDS Soc

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Introduction HIV treatment guidelines now recommend antiretroviral therapy (ART) initiation regardless of CD4 count to maximize benefit both for the individual and society. It is unknown whether the initiation of ART at higher CD4 counts would affect adherence levels. We investigated whether initiating ART at higher CD4 counts was associated with sub‐optimal adherence (<95%) during the first 12 months of ART.MethodsA prospective cohort study nested within a two‐arm cluster‐randomized trial of universal test and treat was implemented from March 2012 to June 2016 to measure the impact of ART on HIV incidence in rural KwaZulu‐Natal. ART was initiated regardless of CD4 count in the intervention arm and according to national guidelines in the control arm. ART adherence was measured monthly using a visual analogue scale (VAS) and pill counts (PC). HIV viral load was measured at ART initiation, three and six months, and six‐monthly thereafter. We pooled data from participants in both arms and used random‐effects logistic regression models to examine the association between CD4 count at ART initiation and sub‐optimal adherence, and assessed if adherence levels were associated with virological suppression.ResultsAmong 900 individuals who initiated ART ≥12 months before study end, median (IQR) CD4 at ART initiation was 350 cells/mm3 (234, 503); median age was 34.6 years (IQR 27.4 to 46.4) and 71.7% were female. Adherence was sub‐optimal in 14.7% of visits as measured by VAS and 20.7% by PC. In both the crude analyses and after adjusting for potential confounders, adherence was not significantly associated with CD4 count at ART initiation (adjusted OR for linear trend in sub‐optimal adherence with every 100 cells/mm3 increase in CD4 count: 1.00, 95% CI 0.95 to 1.05, for VAS, and 1.03, 95% CI 0.99 to 1.07, for PC). Virological suppression at 12 months was 97%. Optimal adherence by both measures was significantly associated with virological suppression (p < 0.001 for VAS; p = 0.006 for PC).ConclusionsWe found no evidence that higher CD4 counts at ART initiation were associated with sub‐optimal ART adherence in the first 12 months. Our findings should alleviate concerns about adherence in individuals initiating ART at higher CD4 counts, however long‐term outcomes are needed. ClinicalTrials.gov NCT01509508.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Universal test and treat is not associated with sub‐optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial

Iwuji

McGrath

Calmy³

et al. 2018

J Intern AIDS Soc

View full text Add to dashboard Cite

show abstract

“…In both studies, the reference group comprised individuals with advanced HIV disease based on the reported median CD4 count at ART initiation. Our cohort comprised individuals with a higher median CD4 count at ART initiation than in those studies and findings corroborate that seen in high income countries reported in the systematic review by Bock et al [17]. WHO recommends universal test and treat for HIV [1]; South Africa has already adopted this recommendation Using either adherence measure, men had more than double the odds of sub-optimal adherence compared with women, similar to findings reported in two studies in Tanzania [19] and South Africa [20].…”

Section: Discussionsupporting

confidence: 79%

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

et al. 2018

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“…The International Antiviral Society‐USA guideline also recommended initiating ART in all HIV+ adults in 2012 . Although HIV+ persons in recent periods have likely initiated ART at a higher CD4 count on average than those in earlier periods , a recent systematic review found no consistent association between baseline CD4 count and ART adherence in routine clinical settings . When we separately examined patients who initiated ART in 2012 (Table , implementation rate during persistent episode), the estimate of ART implementation rate and its trend remained similar between those in 2012 and those in the immediately preceding years.…”

Section: Discussionmentioning

confidence: 76%

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

et al. 2019

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Introduction Adherence to antiretroviral therapy ( ART ) is essential to reduce HIV ‐related morbidity and mortality as well as the risk of virological failure and HIV transmission. We determined the trends in ART adherence during the periods of therapeutic advances, wider use of ART and greater attention to ART adherence. To understand the general trends in medication adherence, we compared ART adherence with medications for other common chronic conditions. Methods A retrospective cohort study using Medicaid claims between 2001 and 2012 from 14 US states with the highest HIV prevalence. Medicaid is the largest source of care for HIV patients in the US . We identified Medicaid beneficiaries with HIV who initiated ART between 2001 and 2010 (n=23,343). Comparison groups included (1) HIV ‐ persons who initiated a statin, angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker ( ACEI / ARB ), or metformin and (2) HIV + persons who initiated these control medications while on and not on ART . We estimated adjusted odds of >90% medication implementation during the two years following initiation. Results The proportion of HIV + persons with >90% ART implementation increased from 33.5% in those who initiated in 2001 to 46.4% in 2005 and 52.4% in 2010. ART initiators in 2007 to 2010 had 53% increased odds of >90% implementation compared to those in 2001 to 2003 (adjusted OR 1.53, 99% CI : 1.34 to 1.75). Older age, male, White race, newer ART regimens and absence of substance use indicators were also associated with increased odds of >90% ART implementation. No or minimal improvements were found in the implementation of control medications in HIV ‐ persons. For HIV ‐ persons, the adjusted OR s comparing 2007–2010 to 2001–2003 were 1.06, 1.01 and 1.19 for statins, ACEI / ARB , metformin respectively. HIV + persons who were on ART had, on average, 15.0 ( SD : 4.2) and 16.1 ( SD : 3.4) percentage points higher >90% implementation rates of concurrent statins, ACEI / ARB ...

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Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Cited by 24 publications

References 48 publications

Universal test and treat is not associated with sub‐optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial

Universal test and treat is not associated with sub‐optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

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