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

作者：Nanina Anderegg, Klea Panayidou, Yao Abo, Belén Alejos, Keri N. Althoff, Kathryn Anastos, Andrea Antinori, Éric Balestre, Renaud Becquet, Antonella Castagna, Barbara Castelnuovo, Geneviève Chêne, Lara E. Coelho, Intira Jeannie Collins, Dominique Costagliola, Brenda Crabtree‐Ramírez, François Dabis, Antonella d’Arminio Monforte, Mary‐Ann Davies, Stéphane De Wit, Valérie Delpech, Nicole De La Mata, Stephany N. Duda, A Freeman, Stephen J. Gange, Katharina Grabmeier‐Pfistershammer, Barbara Gunsenheimer‐Bartmeyer, Awachana Jiamsakul, Mari M Kitahata, Matthew Law, Christian Manzardo, Catherine C. McGowan, Laurence Meyer, Richard E. Moore, Cristina Mussini, Gertrude Nakigoz, Denis Nash, Oon Tek Ng, Niels Obel, Nikos Pantazis, Armel Poda, Dorthe Raben, Peter Reiss, Larry Riggen, Caroline Sabin, Jean d’Amour Sinayobye, Anders Sönnerborg, Marcel Stoeckle, Claire Thorne, Carlo Torti, Christella Twizere, Jan‐Christian Wasmuth, Linda Wittkop, Kara Wools-Kaloustian, Marcel Yotebieng, Ole Kirk, Matthias Egger · 发表于：Clinical Infectious Diseases · 年份：2017 · DOI：10.1093/cid/cix915 · 被引用次数：122 · 研究领域：HIV/AIDS Research and Interventions、HIV Research and Treatment、HIV-related health complications and treatments

Background: Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively). Methods: We included HIV-infected individuals aged ≥16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-effect models were used to smooth trends in median CD4 cell counts. Results: A total of 951855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/µL (95% confidence interval, 58-104/µL) to 287/µL (250-328/µL) in LICs, from 99/µL (71-140/µL) to 234/µL (192-285/µL) in LMICs, from 71/µL (49-104/µL) to 311/µL (255-379/µL) in UMICs, and from 161/µL (143-181/µL) to 327/µL (286-372/µL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions: Median CD4 cell counts at the start of cART increased in all income grou...