ArticleJournal of epidemiology and community health2016
CD4 count at antiretroviral therapy initiation and the risk of loss to follow-up: results from a multicentre cohort study.
Article in Journal of epidemiology and community health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed.
- Characteristics and six-month viral load suppression of clients presenting with advanced HIV disease in South Africa.PLOS global public health · 2025Article
- Article
- CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the "Treat-All" Era in Rural South Africa: An Interrupted Time Series Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Article
- Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study.AIDS and behavior · 2022Article
- Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis.BMJ open · 2021Article
- Implementing 'universal' access to antiretroviral treatment in South Africa: a scoping review on research priorities.Health policy and planning · 2021Article
- Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017.Journal of the International AIDS Society · 2021Article
- Trends in CD4 and viral load testing 2005 to 2018: multi-cohort study of people living with HIV in Southern Africa.Journal of the International AIDS Society · 2020Article
- Lost to follow up rate in the first year of ART in adults initiated in a universal test and treat programme: a retrospective cohort study in Ekurhuleni District, South Africa.The Pan African medical journal · 2020Article
- Article
- Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland.Tropical medicine & international health : TM & IH · 2019Article
- Early outcomes after implementation of treat all in Rwanda: an interrupted time series study.Journal of the International AIDS Society · 2019Observational
- The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance.JMIR public health and surveillance · 2019Article
- Loss to follow-up from antiretroviral therapy clinics: A systematic review and meta-analysis of published studies in South Africa from 2011 to 2015.Southern African journal of HIV medicine · 2019Article
- Altered Immunity and Microbial Dysbiosis in Aged Individuals With Long-Term Controlled HIV Infection.Frontiers in immunology · 2019Article
- Article
- Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.PloS one · 2019Article
- Persons living with HIV with advanced HIV disease: need for novel care models.Journal of the International AIDS Society · 2018Article
- Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes.Journal of the International AIDS Society · 2018Article
- Article
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11 authors.
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Abstract
backgroundAntiretroviral therapy (ART) initiation is now recommended irrespective of CD4 count. However data on the relationship between CD4 count at ART initiation and loss to follow-up (LTFU) are limited and conflicting.
methodsWe conducted a cohort analysis including all adults initiating ART (2008-2012) at three public sector sites in South Africa. LTFU was defined as no visit in the 6 months before database closure. The Kaplan-Meier estimator and Cox's proportional hazards models examined the relationship between CD4 count at ART initiation and 24-month LTFU. Final models were adjusted for demographics, year of ART initiation, programme expansion and corrected for unascertained mortality.
resultsAmong 17 038 patients, the median CD4 at initiation increased from 119 (IQR 54-180) in 2008 to 257 (IQR 175-318) in 2012. In unadjusted models, observed LTFU was associated with both CD4 counts <100 cells/μL and CD4 counts ≥300 cells/μL. After adjustment, patients with CD4 counts ≥300 cells/μL were 1.35 (95% CI 1.12 to 1.63) times as likely to be LTFU after 24 months compared to those with a CD4 150-199 cells/μL. This increased risk for patients with CD4 counts ≥300 cells/μL was largest in the first 3 months on treatment. Correction for unascertained deaths attenuated the association between CD4 counts <100 cells/μL and LTFU while the association between CD4 counts ≥300 cells/μL and LTFU persisted.
conclusionsPatients initiating ART at higher CD4 counts may be at increased risk for LTFU. With programmes initiating patients at higher CD4 counts, models of ART delivery need to be reoriented to support long-term retention.
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