CD4+ gain percentile curves for monitoring response to antiretroviral therapy in HIV-infected adults. (1st June 2015)

• Record Type: Journal Article
• Authors: Yotebieng, Marcel; Maskew, Mhairi; Van Rie, Annelies
• Is Part Of: AIDS. Volume 29:Number 9(2015)
• Publication Date: 2015-06-01
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000649
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives:</title> <p>We constructed CD4<sup>+</sup> cell count gain percentile distributions standardized by baseline CD4<sup>+</sup> cell count and assessed the association between poor CD4<sup>+</sup> cell count gain and subsequent death and virological failure on antiretroviral therapy (ART).</p> </sec> <sec> <title>Design:</title> <p>Secondary analysis of 10 years of clinical data from a cohort of adults initiated on ART at the Themba Lethu clinic in Johannesburg, South Africa.</p> </sec> <sec> <title>Methods:</title> <p>The generalized additive model for location, scale and shape was used to construct percentile curves for CD4<sup>+</sup> cell count gain standardized by baseline CD4<sup>+</sup> cell count in the first 28 months of ART. Cox proportional models were used to assess the association between lower percentiles (<50th) of CD4<sup>+</sup> cell count gain, and subsequent death and virological failure.</p> </sec> <sec> <title>Results:</title> <p>Among 9640 nonpregnant adults 7406, with available CD4<sup>+</sup> cell count results for CD4<sup>+</sup> gain calculation at 4 months of ART, 843 (8.7%) died subsequently and 1101 (11.4%) experienced virologic failure, respectively. For CD4<sup>+</sup> gains below the third percentile, the adjusted hazard ratios at different time points ranged between 2.72 and 5.73 for death, and between 1.48 and 6.93 for virologic failure. The CD4<sup>+</sup> percentile curves revealed a gradient of increasing risk of subsequent death and virological failure, with lower CD4<sup>+</sup> gain percentiles and increasing time on ART, and were more informative than the WHO criteria for immunological failure or current CD4<sup>+</sup> cell count.</p> </sec> <sec> <title>Conclusion:</title> <p>Percentile curves of CD4<sup>+</sup> cell count gain provide a simple tool for healthcare workers in low-resource settings to monitor response to ART with improved information regarding risk of death and virological failure compared to current WHO criteria for immunological failure.</p> </sec> </abstract>