Impact of Age and Sex on CD4+ Cell Count Trajectories following Treatment Initiation: An Analysis of the Tanzanian HIV Treatment Database

Abstract

ObjectiveNew guidelines recommend that all HIV-infected individuals initiate antiretroviral treatment (ART) immediately following diagnosis. This study describes how immune reconstitution varies by gender and age to help identify poorly reconstituting subgroups and inform targeted testing initiatives.DesignLongitudinal data from the outpatient monitoring system of the National AIDS Control Program in Tanzania.MethodsAn asymptotic nonlinear mixed effects model was fit to post-treatment CD4+ cell count trajectories, allowing for fixed effects of age and sex, and an age by sex interaction.ResultsAcross 220,544 clinic visits from 32,069 HIV-infected patients, age- and sex-specific average CD4+ cell count at ART initiation ranged from 83–136 cells/mm3, long term asymptotic CD4+ cell count ranged from 301–389 cells/mm3, and time to half of maximal CD4+ reconstitution ranged from 3.57–5.68 months. CD4+ cell count at ART initiation and asymptotic CD4+ cell count were 1.28 (95% CI: 1.18–1.40) and 1.25 (95% CI: 1.20–1.31) times higher, respectively, for females compared to males in the youngest age group (19–29 years). Older patients started treatment at higher CD4+ counts but experienced slower CD4+ recovery than younger adults. Treatment initiation at greater CD4+ cell counts was correlated with greater asymptotic CD4+ cell counts within all sex and age groups.ConclusionOlder adults should initiate care early in disease progression because total immune reconstitution potential and rate of reconstitution appears to decrease with age. Targeted HIV testing and care linkage remains crucial for patient populations who tend to initiate treatment at lower CD4+ cell counts, including males and younger adults.

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China

“…This is consistent with observations among both HIV-infected and HIV-uninfected populations (34,43). Although this is most likely due to pathophysiological differences and differential responses to ART between males and females (44)(45)(46), the less exposure of female patients to behaviors that favorite liver disease progression such as smoking and drinking cannot be ruled out (10,(47)(48). Interestingly, we found that homosexual men or men who have sex with men (MSM) were less likely to encounter liver fibrosis progression than heterosexual men.…”

Drug Use is Associated with Anti-CD4 IgG-mediated CD4+ T Cell Death and Poor CD4+ T Cell Recovery in Viral-suppressive HIV-infected Individuals Under Antiretroviral Therapy

“…CD4+ T cell counts were the outcome and log-transformed due to skewness in their distributions. Because sex [41], age [42], and nadir CD4+ T cell counts [43] have been show to associate with CD4+ T cell counts and HIV disease progression, they were included as covariates. An initial regression model was fit, first controlling for each independent variable separately, and then a final model was fit adjusting for all covariates to evaluate bivariate relationships and unique relationships.…”

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

“…These studies demonstrated that i) the CD4 count at the start of ART was the strongest predictor of CD4 count recovery, [29] ii) CD4 recovery was rapid early in the course of ART but stabilised around 12 months post ART initiation, [30] and iii) CD4 count recovery is slower in males compared to females and in older individuals compared to younger individuals. [7,8,31,32] However, the comparison of CD4 count recovery by province and calendar year is new. A number of factors may contribute to the variation in CD4 counts across provinces even after adjusting for confounding factors such as age, gender, baseline CD4 counts and viral load suppression.…”