CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme
Background: People living with HIV (PLHIV) who have low CD4 counts require advanced clinical care (ACC) to minimise morbidity and mortality risk. These patients include immunological non-responders (INRs) with low CD4 counts despite a suppressed viral load. Objectives: To determine the proportion o...
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| Format: | Article |
| Language: | English |
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AOSIS
2020-12-01
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| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1165 |
| _version_ | 1828198635257462784 |
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| author | Rivka R. Lilian Natasha Davies Louise Gilbert James A. McIntyre Helen E. Struthers Kate Rees |
| author_facet | Rivka R. Lilian Natasha Davies Louise Gilbert James A. McIntyre Helen E. Struthers Kate Rees |
| author_sort | Rivka R. Lilian |
| collection | DOAJ |
| description | Background: People living with HIV (PLHIV) who have low CD4 counts require advanced clinical care (ACC) to minimise morbidity and mortality risk. These patients include immunological non-responders (INRs) with low CD4 counts despite a suppressed viral load.
Objectives: To determine the proportion of patients with low CD4 counts after antiretroviral therapy (ART) initiation and to describe INRs within that group.
Methods: Routine Three Interlinked Electronic Registers.Net (TIER.Net) data from four South African districts were analysed for adult PLHIV on ART 12 months. Immunological non-responders were defined as patients on ART 4 years who were virally suppressed (viral load 1000 copies/mL) with a CD4 count ≤ 350 cell/mm3.
Results: Baseline CD4 was recorded for 80.9% of the 869 571 patients newly initiating ART, with 37.2% of those starting ART since 2017 having baseline counts ≤ 200 cells/mm3. Amongst all 1 178 190 patients on ART, only 46.5% had a CD4 test after ART initiation and of these, 14.3% had CD4 ≤ 200 cells/mm3. This proportion was highest amongst patients on ART ≤ 2 years (19.7%) (p 0.001). Amongst virally suppressed patients, 20.0% were INRs. Immunological non-response was significantly more likely amongst patients on second-line ART (adjusted odds ratio [aOR] 1.79), those aged 35-45 and ≥ 45 years (aOR 1.15 and 1.50, respectively), males (aOR 2.28) and patients with confirmed TB (aOR 2.49), and was significantly less likely in cases with higher baseline CD4 count (aOR 0.35).
Conclusion: CD4 testing subsequent to ART initiation is poorly implemented and there is a notable proportion of patients with low CD4 counts. Guidelines regarding CD4 testing and ACC need to be more widely implemented to identify patients with low CD4 counts and improve their outcomes. |
| first_indexed | 2024-04-12T10:41:42Z |
| format | Article |
| id | doaj.art-a0c94b2a87554e38a24835fdf7b406c2 |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-04-12T10:41:42Z |
| publishDate | 2020-12-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-a0c94b2a87554e38a24835fdf7b406c22022-12-22T03:36:35ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512020-12-01211e1e410.4102/sajhivmed.v21i1.1165718CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programmeRivka R. Lilian0Natasha Davies1Louise Gilbert2James A. McIntyre3Helen E. Struthers4Kate Rees5Anova Health Institute, JohannesburgAnova Health Institute, JohannesburgAnova 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, Department of Community Health, School of Public Health, University of the Witwatersrand, JohannesburgBackground: People living with HIV (PLHIV) who have low CD4 counts require advanced clinical care (ACC) to minimise morbidity and mortality risk. These patients include immunological non-responders (INRs) with low CD4 counts despite a suppressed viral load. Objectives: To determine the proportion of patients with low CD4 counts after antiretroviral therapy (ART) initiation and to describe INRs within that group. Methods: Routine Three Interlinked Electronic Registers.Net (TIER.Net) data from four South African districts were analysed for adult PLHIV on ART 12 months. Immunological non-responders were defined as patients on ART 4 years who were virally suppressed (viral load 1000 copies/mL) with a CD4 count ≤ 350 cell/mm3. Results: Baseline CD4 was recorded for 80.9% of the 869 571 patients newly initiating ART, with 37.2% of those starting ART since 2017 having baseline counts ≤ 200 cells/mm3. Amongst all 1 178 190 patients on ART, only 46.5% had a CD4 test after ART initiation and of these, 14.3% had CD4 ≤ 200 cells/mm3. This proportion was highest amongst patients on ART ≤ 2 years (19.7%) (p 0.001). Amongst virally suppressed patients, 20.0% were INRs. Immunological non-response was significantly more likely amongst patients on second-line ART (adjusted odds ratio [aOR] 1.79), those aged 35-45 and ≥ 45 years (aOR 1.15 and 1.50, respectively), males (aOR 2.28) and patients with confirmed TB (aOR 2.49), and was significantly less likely in cases with higher baseline CD4 count (aOR 0.35). Conclusion: CD4 testing subsequent to ART initiation is poorly implemented and there is a notable proportion of patients with low CD4 counts. Guidelines regarding CD4 testing and ACC need to be more widely implemented to identify patients with low CD4 counts and improve their outcomes.https://sajhivmed.org.za/index.php/hivmed/article/view/1165cd4hivsouth africaadvanced clinical careimmunological non-respondertier.net |
| spellingShingle | Rivka R. Lilian Natasha Davies Louise Gilbert James A. McIntyre Helen E. Struthers Kate Rees CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme Southern African Journal of HIV Medicine cd4 hiv south africa advanced clinical care immunological non-responder tier.net |
| title | CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme |
| title_full | CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme |
| title_fullStr | CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme |
| title_full_unstemmed | CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme |
| title_short | CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme |
| title_sort | cd4 testing after initiation of antiretroviral therapy analysis of routine data from the south african hiv programme |
| topic | cd4 hiv south africa advanced clinical care immunological non-responder tier.net |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/1165 |
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