Trial reportAIDS (London, England)2010
Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/microl is associated with improved treatment outcomes in South Africa.
Trial report in AIDS (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2014Pooled it
- Rates of emergence of HIV drug resistance in resource-limited settings: a systematic review.Antiviral therapy · 2013Pooled it
- Implementation and Operational Research: Cost-Effectiveness of Antiretroviral Therapy and Isoniazid Prophylaxis to Reduce Tuberculosis and Death in People Living With HIV in Botswana.Journal of acquired immune deficiency syndromes (1999) · 2015Trial
- Trial
- PSGL-1, a Strategic Biomarker for Pathological Conditions in HIV Infection: A Hypothesis Review.Viruses · 2023Review
- Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study.International journal of STD & AIDS · 2022Article
- ART uptake and adherence among female sex workers (FSW) globally: A scoping review.Global public health · 2022Article
- An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China.Scientific reports · 2019Article
- High Proportions of Patients With Advanced HIV Are Antiretroviral Therapy Experienced: Hospitalization Outcomes From 2 Sub-Saharan African Sites.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Prognosis of HIV Patients Receiving Antiretroviral Therapy According to CD4 Counts: A Long-term Follow-up study in Yunnan, China.Scientific reports · 2017Article
- Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province.BMC public health · 2017Article
- Article
- Treatment outcomes and their determinants in HIV patients on Anti-retroviral Treatment Program in selected health facilities of Kembata and Hadiya zones, Southern Nations, Nationalities and Peoples Region, Ethiopia.BMC public health · 2015Article
- Regression discontinuity designs in epidemiology: causal inference without randomized trials.Epidemiology (Cambridge, Mass.) · 2014Article
- Retention and risk factors for attrition in a large public health ART program in Myanmar: a retrospective cohort analysis.PloS one · 2014Article
- Article
- Article
- Cohort profile: the Themba Lethu Clinical Cohort, Johannesburg, South Africa.International journal of epidemiology · 2013Article
- Initiating antiretroviral therapy when presenting with higher CD4 cell counts results in reduced loss to follow-up in a resource-limited setting.AIDS (London, England) · 2013Article
- Entry, Retention, and Virological Suppression in an HIV Cohort Study in India: Description of the Cascade of Care and Implications for Reducing HIV-Related Mortality in Low- and Middle-Income Countries.Interdisciplinary perspectives on infectious diseases · 2013Article
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Authors and funding
11 authors.
Funding
Abstract
objectivesTo compare treatment outcomes by starting CD4 cell counts using data from the Comprehensive International Program of Research on AIDS-South Africa trial.
designAn observational cohort study.
methodsPatients presenting to primary care clinics with CD4 cell counts below 350 cells/microl were randomized to either doctor or nurse-managed HIV care and followed for at least 2 years after antiretroviral therapy (ART) initiation. Clinical and laboratory outcomes were compared by baseline CD4 cell counts.
resultsEight hundred and twelve patients were followed for a median of 27.5 months and 36% initiated ART with a CD4 cell count above 200 cells/microl. Although 10% of patients failed virologically, the risk was nearly double among those with a CD4 cell count of 200 cells/microl or less vs. above 200 cells/microl (12.2 vs. 6.8%). Twenty-one deaths occurred, with a five-fold increased risk for the low CD4 cell count group (3.7 vs. 0.7%). After adjustment, those with a CD4 cell count of 200 cells/microl had twice the risk of death/virologic failure [hazard ratio 1.9; 95% confidence interval (CI), 1.1-3.3] and twice the risk of incident tuberculosis (hazard ratio 1.90; 95% CI, 0.89-4.04) as those above 200 cells/microl. Those with either a CD4 cell count of 200 cells/microl or less (hazard ratio 2.1; 95% CI, 1.2-3.8) or a WHO IV condition (hazard ratio 2.9; 95% CI, 0.93-8.8) alone had a two-to-three-fold increased risk of death/virologic failure vs. those with neither, but those with both conditions had a four-fold increased risk (hazard ratio 3.9; 95% CI, 1.9-8.1). We observed some decreased loss to follow-up among those initiating ART at less than 200 cells/microl (hazard ratio 0.79; 95% CI, 0.50-1.25).
conclusionPatients initiating ART with higher CD4 cell counts had reduced mortality, tuberculosis and less virologic failure than those initiated at lower CD4 cell counts. Our data support increasing CD4 cell count eligibility criteria for ART initiation.
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