ArticleJournal of acquired immune deficiency syndromes (1999)2013
CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Therapeutic HIV-1 Tat vaccination promotes durable immune reconstitution and reservoir reduction in ART-treated adults with clade C infection: a 12-year follow-up study.Frontiers in immunology · 2026Trial
- Assessing rates and contextual predictors of 5-year mortality among HIV-infected and HIV-uninfected individuals following HIV testing in Durban, South Africa.BMC infectious diseases · 2019Trial
- Economic Costs and Health-Related Quality of Life Outcomes of HIV Treatment After Self- and Facility-Based HIV Testing in a Cluster Randomized Trial.Journal of acquired immune deficiency syndromes (1999) · 2017Trial
- High Detection Rate of HIV Drug Resistance Mutations among Patients Who Fail Combined Antiretroviral Therapy in Manaus, Brazil.BioMed research international · 2021Article
- Observational
- How varying CD4 criteria for treatment initiation was associated with mortality of HIV-patients? A retrospective analysis of electronic health records from Andhra Pradesh, India.Journal of global health · 2020Article
- When Global ART Budgets Cannot Cover All Patients, Who Should Be Eligible?Journal of acquired immune deficiency syndromes (1999) · 2019Review
- "My future is bright…I won't die with the cause of AIDS": ten-year patient ART outcomes and experiences in South Africa.Journal of the International AIDS Society · 2018Article
- Cost-Effectiveness of Community-based Human Immunodeficiency Virus Self-Testing in Blantyre, Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Article
- The CD4 slope can be a predictor of immunologic recovery in advanced HIV patients: a case-control study.The Korean journal of internal medicine · 2015Article
- The Day-Hospital of the University Hospital, Bobo Dioulasso: An Example of Optimized HIV Management in Southern Burkina Faso.PloS one · 2015Observational
- French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults.Journal of the International AIDS Society · 2014Article
- Prevalence, Profile and Treatment Outcome of Tuberculosis-Human Immunodeficiency Virus Co-Infection in South Eastern Nigeria: A 3-Year Retrospective Study.Nigerian medical journal : journal of the Nigeria Medical AssociationArticle
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundIn many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information.
methodsWe analyzed data from a large multicohort study in South Africa, where HIV RNA is routinely monitored. Adult HIV-positive patients initiating cART between 2003 and 2010 were included. Mortality was analyzed in Cox models; CD4 count slope by HIV RNA level was assessed using linear mixed models.
resultsAbout 44,829 patients (median age: 35 years, 58% female, median CD4 count at cART initiation: 116 cells/mm) were followed up for a median of 1.9 years, with 3706 deaths. Mean CD4 count slopes per week ranged from 1.4 [95% confidence interval (CI): 1.2 to 1.6] cells per cubic millimeter when HIV RNA was <400 copies per milliliter to -0.32 (95% CI: -0.47 to -0.18) cells per cubic millimeter with >100,000 copies per milliliter. The association of CD4 slope with mortality depended on current CD4 count: the adjusted hazard ratio (aHRs) comparing a >25% increase over 6 months with a >25% decrease was 0.68 (95% CI: 0.58 to 0.79) at <100 cells per cubic millimeter but 1.11 (95% CI: 0.78 to 1.58) at 201-350 cells per cubic millimeter. In contrast, the aHR for current CD4 count, comparing >350 with <100 cells per cubic millimeter, was 0.10 (95% CI: 0.05 to 0.20).
conclusionsAbsolute CD4 count remains a strong risk for mortality with a stable effect size over the first 4 years of cART. However, CD4 count slope and HIV RNA provide independently added to the model.
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