Observational studyJournal of the International AIDS Society2014
Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients.
Observational study in Journal of the International AIDS Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.
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Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prevalence of hepatotoxicity among HIV-infected patients in Ethiopia: a systematic review and meta-analysis.BMC infectious diseases · 2022Pooled it
- Antiretroviral therapy use and CD4 cell count among people who inject drugs living with HIV in southern Vietnam.BMC infectious diseases · 2026Article
- Temporal trends in tuberculosis and time from enrolment in care to antiretroviral therapy initiation: A multicountry cohort study from Latin America.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025Article
- Factors associated with late initiation of antiretroviral therapy in Iran's HIV/AIDS surveillance data.Scientific reports · 2024Article
- Development of a multiassay algorithm (MAA) to identify recent HIV infection in newly diagnosed individuals in Indonesia.iScience · 2023Article
- Factors Associated With Delayed and Late Initiation of Antiretroviral Therapy Among Patients With HIV in Beijing, China, 2010-2020.International journal of public health · 2023Article
- Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019.Infectious diseases and therapy · 2022Article
- Determinants of Late HIV Presentation at Ndlavela Health Center in Mozambique.International journal of environmental research and public health · 2022Article
- Missed opportunities for earlier diagnosis of HIV infection in people living with HIV in Thailand.PLOS global public health · 2022Article
- Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992-2018: A Cohort Study.Frontiers in public health · 2022Article
- Evaluation of the Outcome of Antiviral Therapy among Individuals Infected HIV-1 in Suqian District of Jiangsu Province, China.Iranian journal of public health · 2021Article
- Factors associated with prognostic or treatment outcomes in HIV/AIDS patients with and without hypertension in Eswatini.Scientific reports · 2021Article
- A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala.Journal of fungi (Basel, Switzerland) · 2021Article
- Clinical outcomes of people living with human immunodeficiency virus (HIV) with diffuse large B-cell lymphoma (DLBCL) in Shanghai, China.Chinese medical journal · 2020Article
- Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015.Yonsei medical journal · 2020Article
- Observational
- Multilevel ordinal model for CD4 count trends in seroconversion among South Africa women.BMC infectious diseases · 2020Article
- Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis.Journal of the International AIDS Society · 2020Article
- 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
- Assessment of Pattern of CD4+ T-Cell Recovery Among Human Immunodeficiency Virus Patients After Initiation of Highly Active Antiretroviral Therapy at Arsi Negelle Health Center, Ethiopia: A Retrospective Cross-Sectional Study.HIV/AIDS (Auckland, N.Z.) · 2020Article
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Authors and funding
26 authors.
Funding
Abstract
introductionAlthough antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation.
methodsData from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm(3) or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined.
resultsA total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm(3). Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm(3) in 2008 to a peak of 302 cells/mm(3) after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p<0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p=0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p<0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p=0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1.-4.36; p=0.035).
conclusionsMedian CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.
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