CitationClouse, Kate; Pettifor, Audrey E.; Maskew, Mhairi; Bassett, Jean F.; Van Rie, Annelies T.; Gay, Cynthia L.; Behets, Frieda M.-T. F.; Sanne, Ian; & Fox, Matthew P. (2013). Initiating Antiretroviral Therapy When Presenting with Higher CD4 Cell Counts Results in Reduced Loss to Follow-up in a Resource-Limited Setting. AIDS, 27(4), 645-650. PMCID: PMC3646627
AbstractOBJECTIVE: In August 2011, South Africa expanded its adult antiretroviral treatment (ART) guidelines to allow treatment initiation at CD4 values =350 cells/mul. Mortality and morbidity are known to be reduced when initiating at higher CD4 levels; we explored the impact on patient loss to follow-up.
DESIGN: An observational cohort study.
METHODS: We analyzed routine data of 1430 adult patients initiating ART from April-December 2010 from a Johannesburg primary healthcare clinic offering ART initiation at CD4 =350 cells/mul since 2010. We compared loss to follow-up (>/=3 months late for the last scheduled visit), death and incident tuberculosiswithin one year of ART initiation for those initiating at CD4 values =200 versus 201-350 cells/mul.
RESULTS: Half (52.0%) of patients presented in the lower CD4 group (=200 cells/mul, median: 105cells/mul, IQR: 55-154) and initiated ART, and 48.0% in the higher group (CD4 201-350 cells/mul, median: 268cells/mul, IQR: 239-307). The proportion of females and pregnant women was greater in the high CD4 group; the lower CD4 group included more patients with prevalent tuberculosis. Among men and non-pregnant women, initiating at 201-350 cells/mulwas associated with 26-42% reduced loss to follow-up compared to those initiating =200 cells/mul. We found no CD4 effect among pregnant women. Risk of mortality (aHR 0.34, 95%CI 0.13-0.84) and incident tuberculosis (aHR 0.44, 95%CI 0.23-0.85) was lower among the higher CD4 group.
CONCLUSIONS: This is one of the first studies from a routine clinical setting to demonstrate South Africa's 2011 expansion of ART treatment guidelines can be enacted without increasing program attrition.
Reference TypeJournal Article
Pettifor, Audrey E.
Bassett, Jean F.
Van Rie, Annelies T.
Gay, Cynthia L.
Behets, Frieda M.-T. F.
Fox, Matthew P.