ArticleAIDS (London, England)2015
Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes.
Article in AIDS (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
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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, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- From CD4-Based Initiation to Treating All HIV-Infected Adults Immediately: An Evidence-Based Meta-analysis.Frontiers in immunology · 2018Pooled it
- Universal test and treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial.Journal of the International AIDS Society · 2018Trial
- Brief Report: HIV Drug Resistance in Adults Failing Early Antiretroviral Treatment: Results From the HIV Prevention Trials Network 052 Trial.Journal of acquired immune deficiency syndromes (1999) · 2016Trial
- DDIT4 upregulation associates with gammadelta T Cells dysfunction in ART-suppressed people living with HIV-1.BMC infectious diseases · 2026Article
- Risk of Mortality Associated with Rapid versus Delayed ART Initiation and Associated Factors Among Late-Presenting People with HIV: An 8-Year Retrospective Analysis in China.Infection and drug resistance · 2026Article
- Beyond antiretroviral treatment: Health-related quality of life of patients receiving antiretroviral treatment at a tertiary hospital in South Africa.Dialogues in health · 2025Article
- Demographic and clinical factors correlated with clinical outcomes among people with HIV treated by antiretroviral therapy: a retrospective cohort study.BMC infectious diseases · 2024Article
- Clinical and demographic predictors of antiretroviral efficacy in HIV-HBV co-infected patients.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2021Article
- Effect of antiretroviral therapy initiation time and baseline CD4Global health action · 2021Article
- Effect of Traditional Chinese Medicine Therapy on the Trend in CD4Evidence-based complementary and alternative medicine : eCAM · 2021Article
- Evaluation of Selected Outcomes of Combination Antiretroviral Therapy: Yemen Cohort Retrospective Descriptive Studies.Scientific reports · 2019Article
- The syndemic effect of HIV/HCV co-infection and mental health disorders on acute care hospitalization rate among people living with HIV/AIDS: a population-based retrospective cohort study.Canadian journal of public health = Revue canadienne de sante publique · 2019Article
- The potential impact of initiating antiretroviral therapy with integrase inhibitors on HIV transmission risk in British Columbia, Canada.EClinicalMedicine · 2019Article
- Nationwide Cohort Study of Antiretroviral Therapy Timing: Treatment Dropout and Virological Failure in China, 2011-2015.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Observational
- Duration of Human Immunodef iciency Virus Infection at Diagnosis among New Human Immunodef iciency Virus Cases in Dehong, Yunnan, China, 2008-2015.Chinese medical journal · 2018Article
- HIV Drug Resistance in Adults Receiving Early vs. Delayed Antiretroviral Therapy: HPTN 052.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program.BMC research notes · 2018Article
- Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China: A Nationwide, Retrospective Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Observational
- Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study.Scientific reports · 2017Observational
- Estimation of measurement error in plasma HIV-1 RNA assays near their limit of quantification.PloS one · 2017Article
Corrections and comments
- Erratum issued
Authors and funding
11 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThere is limited research investigating the possible mechanisms of how starting combination antiretroviral therapy (cART) at a higher CD4 cell count decreases mortality. This study investigated the association between initiating cART with short-term and long-term achievement of viral suppression; emergence of any drug resistance and of an AIDS-defining illness (ADI); long-term treatment adherence; and all-cause mortality.
methodsThis retrospective cohort study included 4120 naive patients who initiated cART between 2000 and 2012. Patients were followed until 2013, death or until the last contact date (varied by outcome). The main exposure was the interaction between period of cART initiation (2000-2006 and 2007-2012) and CD4 cell count at cART initiation (<500 versus ≥500 cells/μl). We considered both baseline and longitudinal covariates. We fitted different multivariable models using cross-sectional and longitudinal statistical methods, depending on the outcome.
resultsPatients who initiated cART with a CD4 cell count at least 500 cells/μl in 2007-2012 had an increased likelihood of achieving viral suppression at 9 months and of maintaining an adherence level of at least 95% over time, and the lowest probability of developing any resistance and an ADI during follow-up. These patients were not the ones with the highest likelihood of maintaining viral suppression over time, most likely due to viral load blips experienced during the follow-up.
conclusionThe outcomes in this study likely play an important role in explaining the positive impact of early cART initiation on mortality. These results should alleviate some of the concerns clinicians may have when initiating cART in patients with high CD4s as recommended by current treatment guidelines.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.