ArticlePloS one2023
Low pre-ART CD4 count is associated with increased risk of clinical progression or death even after reaching 500 CD4 cells/μL on ART.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- A novel enterotype enriched with respiratory super-dominant pathobionts is associated with immunosuppression in pulmonary tuberculosis patients.Journal of translational medicine · 2026Article
- HIV viral suppression outcomes of Tenofovir- and Abacavir-based antiretroviral regimens among children on ART in Zambia.Frontiers in public health · 2026Article
- The effect of amphetamine-type stimulants on immune response in HIV-infected individuals: a retrospective cohort study.Frontiers in immunology · 2026Article
- Cause-specific hazards of antiretroviral therapy programmatic adherence, defaulting and mortality among HIV/AIDS patients who had attained CD4 count recovery after antiretroviral therapy initiation in South Africa.Frontiers in reproductive health · 2026Article
- Challenges in the Vaccination of HIV-Infected Individuals.Vaccines · 2025Review
- Defining and Predicting HIV Immunological Non-Response: A Multi-Definition Analysis from an Indonesian Cohort.Viruses · 2025Article
- Species-level enterosignatures predict clinical phenotypes in chronic hepatitis B and causal triangulation of gut-metabolite-CHB interactions.Frontiers in microbiology · 2025Article
- Marginal structural Cox model for estimating the effect of Chinese medicine on the survival of people living with HIV: a 17-year real-world retrospective cohort study.Frontiers in public health · 2025Article
- Investigating the Determinants of Mortality before CD4 Count Recovery in a Cohort of Patients Initiated on Antiretroviral Therapy in South Africa Using a Fine and Gray Competing Risks Model.Tropical medicine and infectious disease · 2024Article
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Authors and funding
17 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionClinical disadvantages of initiating ART at low CD4 counts have been clearly demonstrated but whether any excess risk remains even after reaching relatively high/safe CD4 levels remains unclear. We explore whether individuals starting ART with <500 CD4 cells/μL who increased their CD4 count above this level, have, from this point onwards, similar risk of clinical progression to serious AIDS/non-AIDS events or death with individuals starting ART with ≥500 CD4 cells/μL.
methodsData were derived from a multicenter cohort (AMACS). Adults, starting PI, NNRTI or INSTI based ART, in or after 2000 were eligible, provided they started ART with ≥500 ("High CD4") or started with CD4 <500 cells/μL but surpassed this threshold while on ART ("Low CD4"). Baseline was the date of ART initiation ("High CD4") or of first reaching 500 CD4 cells/μL ("Low CD4"). Survival analysis, allowing for competing risks, was used to explore the risk of progression to study's endpoints.
resultsThe study included 694 persons in the "High CD4" and 3,306 in the "Low CD4" group. Median (IQR) follow-up was 66 (36, 106) months. In total, 257 events (40 AIDS related, 217 SNAEs) were observed. Rates of progression did not differ significantly between the two groups but the subgroup of those initiating ART with <200 CD4 cells/μL had significantly higher risk of progression after baseline, compared to those in the "High CD4" group.
conclusionsIndividuals starting ART with <200 cells/μL remain on increased risk even after reaching 500 CD4 cells/μL. These patients should be closely followed.
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