Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study

Tang, Zhenzhu; Pan, Stephen W.; Ruan, Yuhua; Liu, Xuanhua; Su, Jinming; Zhu, Qingqing; Shen, Zhiyong; Zhang, Heng; Chen, Yi; Lan, Guanghua; Xing, Hui; Liao, Lingjie; Feng, Yi; Shao, Yiming

doi:10.1038/s41598-017-03384-7

Cited by 36 publications

(38 citation statements)

References 31 publications

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“…Several countries have already revised the CD4 threshold to above 500 cells/uL 23 . Recently, another study based on a large ART treatment database in Guangxi showed that HIV infected patients with high CD4+ T cell counts at the time of ART initiation may be at greater risk of treatment attrition 24 . By the end of 2015, a total of 41013 patients terminated ART in China, accounting for 8.7% of the total number of NFATP within China.…”

Section: Discussionmentioning

confidence: 99%

Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program

Liu¹,

Tang

Lan

et al. 2018

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Early antiretroviral therapy (ART) initiation is a recommended public health approach for the prevention of HIV-1 transmission. In this cohort study, we included 13132 serodiscordant couples. ART was initiated for patients with CD4+ T cell counts less than 200 cells/uL, 350 cells/uL, and 500 cells/uL respectively. This divided the ART treated couples into three groups. Univariate and multivariate intention-to-treat analyses were performed to examine the association between the study groups. Early-ART initiation was associated with a 45% lower risk of partner infection than was late-ART initiation (AHR 0.55, 95% CI, 0.37–0.81). Mid-ART initiation was associated with a 39% lower risk of partner infection than was late-ART initiation (AHR 0.61, 95% CI, 0.48–0.78). However, the risk reduction between the early and mid-ART groups was not significant. Drug compliance (AHR 1.55, 95% CI 1.03–2.35) and increased baseline viral load (AHR 1.41, 95% CI 1.33–1.51) were associated with an increased risk of infections among partners in the treatment. Prevention of HIV transmission as a result of early ART initiation was feasible on national and regional scales; however, many factors, such as the motivation to commence ART, adherence, and attrition, may affect the impact of this strategy in programmatic settings.

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Section: Discussionmentioning

confidence: 99%

Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program

Liu¹,

Tang

Lan

et al. 2018

Sci Rep

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“…Previous studies suggest that HIV patient with high CD4 cell count at the time of ART initiation may be at greater risk of treatment attrition. Patient education and healthcare provider training on the importance of ART adherence in patients with high preinitiation CD4 counts should be enhanced 40,41 . The finding that low baseline CD4 counts and poor adherence were significantly associated with immunological failure is supported by several other studies.…”

Section: Discussionmentioning

confidence: 99%

Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Nwaiwu¹,

Akindele²,

Adeyemi³

2020

Nig. J. Paed.

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Background/objective: The World Health Organization (WHO) recommends routine assessment of antiretroviral treatment outcomes to detect treatment failure early and prevent the development of drug resistance. The aim of this study was to describe treatment outcomes of antiretroviral therapy (ART) over 2 years in children living with the human immune deficiency virus enrolled in the paediatric HIV clinic at the Lagos UniversityTeaching Hospital (LUTH).Materials and methods: This was a retrospective study of antiretroviral treatment outcomes in 278 children receiving antiretroviral therapy at the paediatric HIV clinic of LUTH. Demographic, clinical and laboratory data were retrospectively collected from clinical records of pediatric patientswho received antiretroviral therapy for 2 years ( from November 2015 to December 2017) . Virological failure was defined as viral load > 400 copies/ml and immunological failure was defined as a CD4 count <100 cells/mm3 or CD4 % <15% after receiving antiretroviral agents for 12 months. Data was analysed using graph pad prism version 5.0.Results: After 12 months on antiretroviral therapy (ART), 101 (36%) had virological failure while 14 (5%) and 36 (13%) failed immunologically [CD4 count <100 cells/mn3 and CD4 <15% respectively]. Virological blips were observed at 24 months in 6.1% of patients while immunovirological discordance occurred in 30% of patients (poor virological clearance despite good immunological recovery) . High baseline viral load (>5000 copies/ml), poor adherence (<95%) and low baseline CD4 counts (101-249 cells/mn3) were significantly associated with virological failure, while low baseline CD4 counts (<350 cells/mn3) and poor adherence (<95%) were significantly associated with immunologic failure.Conclusion: The treatment outcomes observed in this study are similar to those reported in earlier studies. At 1 and 2 years of antiretroviral therapy , there was immune restoration however 101 (36%) and 87 (31%) respectively had virological failure despite good adherence to therapy and good Immunological restoration. This calls for early initiation and switch to second and third line drugs . Key words: Human immunodeficiency virus (HIV), zidovudine, lamivudine, nevirapine, virological blips, immunovirological discordance , children, Nigeria.

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“…Late diagnosis and delayed treatment of HIV infection contribute to the development of opportunistic infections, such as pneumocystis pneumonia, Talaromyces marneffei infection, etc. In Guangxi, a recent retrospective study revealed that 70.2% of newly diagnosed HIV cases from 2012 to 2016 had a late presentation, and 45.1% had advanced HIV disease [29]. Most patients with late presentation, advanced HIV disease, or ADE have relatively low CD4 + cell count or develop AIDS symptoms.…”

Section: Introductionmentioning

confidence: 99%

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

et al. 2020

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Objective: To evaluate the impact of AIDS-defining events (ADE) on long-term mortality of HIV positive individuals on antiretroviral therapy (ART), a retrospective HIV/AIDS treatment cohort study performed in Southwestern China. Methods: The retrospective cohort was conducted among 6757 HIV/AIDS patients on ART (2NRTIs + 1NNRTI, 2NRTIs + 1PI and Single or two drugs) recruited in Guigang city, Guangxi, China, from January 2004 to December 2018. Participants were divided into ADE and non-ADE groups, and were followed-up every six months to observe treatment outcomes. Comparison of mortality between groups was performed using the log-rank test and Kaplan-Meier analysis. Cox proportional hazard regression was used to explore the risk factors of mortality. 1:1 propensity score matching (PSM) was used to balance confounding factors and adjust the mortality risk. Results: Of 6757 participants with 29,096.06 person-years of follow-up, 16.86% (1139/6757) belonged to ADE group while the others (83.14%) belonged to the non-ADE group. The most common cause of death by ADE was disseminated mycosis (31.65%), followed by recurrent severe bacterial pneumonia (28.48%), herpes zoster (17.72%), and extra-pulmonary tuberculosis (8.86%). The mortality of the ADE group was significantly higher than that of the non-ADE group [3.45/100 person-years (95% CI 2.92-3.97) vs. 2.34/100 person-years (95% CI 2.15-2.52), P<0.001]. The death risk of the ADE group was also higher than that of the non-ADE group [adjusted hazard ratio (aHR) = 1.291, 95% CI 1.061-1.571, P = 0.011], which was confirmed by PSM analysis (aHR = 1.581, 95% CI 1.192-2.099, P = 0.002). Cox analysis indicated that ADE, older age, male gender, previous non-use of cotrimoxazole, advanced WHO clinical stage, and low baseline CD4 + cell count were the risk factors for death. Conclusions: Even on ART, the mortality risk of HIV positive individuals with ADE was higher than those without ADE. Active testing, earlier diagnosis, and timely therapy with ART may reduce the death risk of ADE.

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Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study

Cited by 36 publications

References 31 publications

Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program

Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program

Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

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