Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data
Background: Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality. Objectives: To describe ART initiation and outcome trends over time, with a focus on clients presen...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2019-07-01
|
| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/963 |
| _version_ | 1828827810919088128 |
|---|---|
| author | Rivka R. Lilian Kate Rees Moyahabo Mabitsi James A. McIntyre Helen E. Struthers Remco P.H. Peters |
| author_facet | Rivka R. Lilian Kate Rees Moyahabo Mabitsi James A. McIntyre Helen E. Struthers Remco P.H. Peters |
| author_sort | Rivka R. Lilian |
| collection | DOAJ |
| description | Background: Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality.
Objectives: To describe ART initiation and outcome trends over time, with a focus on clients presenting with advanced HIV-infection, so as to identify interventions to reduce morbidity and mortality.
Methods: Routine TIER.Net data from HIV-infected adults who had a documented baseline CD4 count and were newly initiating ART in Johannesburg or Mopani districts from 2004 to 2017 were analysed. Trends in baseline CD4 count and 5-year mortality were investigated and the population initiating ART with CD4 < 200 cells/mm3 was described.
Results: The Johannesburg and Mopani data sets comprised 203 131 and 101 814 records, respectively. Although median CD4 count increased over time, the proportion of initiations at CD4 < 200 cells/mm3 in 2017 remained high (Johannesburg 39%, Mopani 35%). Mortality was significantly increased among clients with CD4 < 200 compared to those with higher baseline counts (p < 0.001). Even though mortality among clients with low CD4 declined over time, likely because of improved drug regimens, in 2016–2017 mortality was still significantly increased among these clients (p < 0.001). Delivery of cotrimoxazole prophylaxis to clients with low CD4 declined over time to < 30% in 2017 and was associated with clinical stage. Presentation with CD4 < 200 cells/mm3 was associated with older age, male gender and hospitalisation.
Conclusion: A concerningly large proportion of South Africans still initiate ART at low CD4 counts. This is associated with increased mortality and requires targeted interventions to improve delivery of prophylactic regimens and early engagement in care. |
| first_indexed | 2024-12-12T15:08:46Z |
| format | Article |
| id | doaj.art-01ee6302cfbe4455890fe865bb6dcfd0 |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-12-12T15:08:46Z |
| publishDate | 2019-07-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-01ee6302cfbe4455890fe865bb6dcfd02022-12-22T00:20:40ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512019-07-01201e1e1010.4102/sajhivmed.v20i1.963640Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine dataRivka R. Lilian0Kate Rees1Moyahabo Mabitsi2James A. McIntyre3Helen E. Struthers4Remco P.H. Peters5Anova Health Institute, JohannesburgAnova Health Institute, Johannesburg, South Africa; and, School of Public Health and Family Medicine, University of Cape Town, Cape TownAnova Health Institute, JohannesburgAnova Health Institute, Johannesburg, South Africa; and, School of Public Health and Family Medicine, University of Cape Town, Cape TownAnova Health Institute, Johannesburg, South Africa; and, Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape TownAnova Health Institute, Johannesburg, South Africa; and, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, theBackground: Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality. Objectives: To describe ART initiation and outcome trends over time, with a focus on clients presenting with advanced HIV-infection, so as to identify interventions to reduce morbidity and mortality. Methods: Routine TIER.Net data from HIV-infected adults who had a documented baseline CD4 count and were newly initiating ART in Johannesburg or Mopani districts from 2004 to 2017 were analysed. Trends in baseline CD4 count and 5-year mortality were investigated and the population initiating ART with CD4 < 200 cells/mm3 was described. Results: The Johannesburg and Mopani data sets comprised 203 131 and 101 814 records, respectively. Although median CD4 count increased over time, the proportion of initiations at CD4 < 200 cells/mm3 in 2017 remained high (Johannesburg 39%, Mopani 35%). Mortality was significantly increased among clients with CD4 < 200 compared to those with higher baseline counts (p < 0.001). Even though mortality among clients with low CD4 declined over time, likely because of improved drug regimens, in 2016–2017 mortality was still significantly increased among these clients (p < 0.001). Delivery of cotrimoxazole prophylaxis to clients with low CD4 declined over time to < 30% in 2017 and was associated with clinical stage. Presentation with CD4 < 200 cells/mm3 was associated with older age, male gender and hospitalisation. Conclusion: A concerningly large proportion of South Africans still initiate ART at low CD4 counts. This is associated with increased mortality and requires targeted interventions to improve delivery of prophylactic regimens and early engagement in care.https://sajhivmed.org.za/index.php/hivmed/article/view/963TIER.NetAntiretroviral TherapyCD4MortalityHIVSouth Africa |
| spellingShingle | Rivka R. Lilian Kate Rees Moyahabo Mabitsi James A. McIntyre Helen E. Struthers Remco P.H. Peters Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data Southern African Journal of HIV Medicine TIER.Net Antiretroviral Therapy CD4 Mortality HIV South Africa |
| title | Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data |
| title_full | Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data |
| title_fullStr | Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data |
| title_full_unstemmed | Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data |
| title_short | Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data |
| title_sort | baseline cd4 and mortality trends in the south african human immunodeficiency virus programme analysis of routine data |
| topic | TIER.Net Antiretroviral Therapy CD4 Mortality HIV South Africa |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/963 |
| work_keys_str_mv | AT rivkarlilian baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata AT katerees baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata AT moyahabomabitsi baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata AT jamesamcintyre baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata AT helenestruthers baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata AT remcophpeters baselinecd4andmortalitytrendsinthesouthafricanhumanimmunodeficiencyvirusprogrammeanalysisofroutinedata |