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

Abstract

We modeled global time trends in median CD4 cell counts at combination antiretroviral therapy initiation in human immunodeficiency virus–infected adults. These counts have increased in all country income groups since 2002 but generally remained below 350/μL in 2015.

Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries

“…In South Africa, 56.7% of patients entering care in 2017 with very advanced HIV disease were treatment experienced (20). The prevalence of advanced HIV disease was lower in the current study than reported in the literature [18][19][20][21]; however, this could have been due to the variable uses of CD4 testing across included countries within the current study. During the study period, CD4 was still used to monitor treatment as access to viral load testing was significantly below coverage rates in South Africa [5].…”

“…In 2016 in South Africa, for example, nearly a third (32.9%) of over 650,000 HIV-positive patients had advanced HIV disease at the time of their first CD4 count prior to ART initiation [18]. Further, reviewing CD4 data in nearly one million patients attending health care facilities within the IeDEA and COHERE cohorts across 55 countries found that not only has the proportion of patients entering care remained high across settings (31% in low-income countries, 40% in low-and middle-income countries, 29% in high-income countries), but these rates have plateaued over the past few years [19]. Interestingly, many patients entering, or re-entering care, are treatment experienced [20,21].…”

Models of service delivery for optimizing a patient’s first six months on antiretroviral therapy for HIV: an applied research agenda

“…Second, while the model of care for newly-initiated patients has not changed over time, the patients and the drug regimens they are taking have. CD4 counts at treatment initiation have risen steadily since the advent of universal treatment eligibility 14 even as the proportion of patients with advanced disease has remained constant 15 and “re-initiation” of those who have previously interrupted care has become more common 16 . Most newly initiating patients do not need additional clinical care after ART initiation.…”

Providing antiretroviral therapy to all who are HIV positive: the clinical, public health and programmatic benefits of Treat All

“…The first randomized trial to assess the effect of immediate ART at the population level was unable to demonstrate a reduction in HIV incidence, a finding explained by the challenges faced in ensuring adequate linkage to care [18]. This finding is echoed by cohort data demonstrating that despite a progressive guideline evolution toward earlier initiation of ART in recent years, still approximately a third of people starting ART do so at a CD4 cell count <200 cells/mm 3 [19].…”