Immunodeficiency at the start of combination antiretroviral therapy in low-, middle- and high-income countries

University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland
Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, BC, United States of America
University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland
Indiana University School of Medicine. Indianapolis, IN, United States of America
University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland
Université Bordeaux Segalen. Institut de Santé Publique. Epidémiologie et Développement. Bordeaux, BOD, France
CUNY School of Public Health. New York, NY, United States of America
University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland
Mahidol University. Faculty of Medicine Ramathibodi Hospital. Bangkok, BKK, Thailand
Vanderbilt University School of Medicine. Nashville, TN, United States of America
University of Bristol. School of Social and Community Medicine. Bristol, BS, United Kingdom
The University of New South Wales. The Kirby Institute. Sydney, SYD, Australia
Newlands Clinic. Harare, HA, Zimbabwe
Universidad de Chile. Fundación Arriarán. Santiago, SA, Chile
University of Washington School of Medicine Center. Seattle, SEA, United States of America
The University of New South Wales. The Kirby Institute. Sydney, SYD, Australia
University of Cape Town. School of Public Health and Family Medicine. Centre for Infectious Disease Epidemiology and Research. Cape Town, CPT, South Africa
University Pierre et Marie Curie. Paris, PAR, France
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México, DF, México
Research Institute for Health Sciences. Chiang Mai, CNX, Thailand
British Columbia Centre for Excellence in HIV/AIDS. Vancouver, VAN, Canada
University of Cape Town. School of Public Health and Family Medicine. Centre for Infectious Disease Epidemiology and Research. Cape Town, CPT, South Africa
Moi University. Academic Model Providing Access to Health Care. School of Medicine. Faculty of Health Sciences. Eldoret, EDL, Kenya
The HIV Netherlands Australia Thailand Research Collaboration Red Cross. AIDS Research Centre. Bangkok, BKK, Thailand
CHU Sourô Sanou. Bobo-Dioulasso, BOY, Burkina Faso
SolidarMed. African HIV prevention and treatment program. Lucerne, QLJ, Switzerland
Service de Maladies Infectieuses et Tropicales. Abidjan, ABJ, Côte d’Ivoire
Queen Elizabeth Hospital. Hong Kong, HK, China
Boston University. Boston University School of Public Health. Center for Global Health and Development. Department of Epidemiology. Boston, BOS, United States of America / University of the Witwatersrand. Health Economics and Epidemiology Research Office. Johannesburg, JHB, South Africa
Emory University Rollins School of Public Health. Global Health & Infectious Diseases. Departments of Epidemiology. Atlanta, ATL, United States of America
Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, LIM, Peru
Hospital Sungai Buloh. Sungai Buloh, SGB, Malaysia
Aurum Institute. Johannesburg, JHB, South Africa / John Hopkins University School of Medicine, Baltimore, BC, United States of America
Infectious Diseases Institute, Kampala, KLA, Uganda
University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland
Research Institute for Tropical Medicine. Manila, MNL, Philippines
University of Stellenbosch and Tygerberg Hospital. Division of Infectious Diseases. Cape Town, CPT, South Africa
University College London. Research Department of Infection and Population Health, London, LND, United Kingdom
YRG Centre for AIDS Research and Education. Chennai, CH, India
University of Washington School of Medicine Center. Seattle, SEA, United States of America
Ocean Road Cancer Institute. Dar-es-Salaam, DAR, Tanzania
Morogoro Regional Hospital. Morogoro, MORO, Tanzania
National Center for HIV/AIDS. Dermatology & STDs. Phnom Penh, PNH, Cambodia
Fundación Huésped. Buenos Aires, BA, Argentina
University of Milan. San Paolo Hospital. Clinic of Infectious Diseases & Tropical Medicine. Milano, MI, Italy
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil
Taipei Veterans General Hospital and AIDS Prevention and Research Centre. National Yang-Ming University. Taipei, TPE, Taiwan
Centre Médical de Suivi de Donneurs de Sang. Abidjan, ABJ, Cote d’Ivoire
Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya. Badalona, BAD, Spain / CIBER Epidemiología y Salud Pública. Barcelona, BAR, Spain
Zambian Ministry of Health. Lusaka, LUN, Zambia
Yonsei University College of Medicine. Department of Internal Medicine. Division of Infectious Diseases. Seoul, SEL, South Korea
University of KwaZulu-Natal. Africa Centre for Health and Population Studies. Mtubatuba, MTU, South Africa
Family AIDS Care and Education Services. Kisumu, KIS, Kenya
Tumbi Regional Hospital. Kibaha, KIB, Tanzania
Faculty of Medicine Udayana University & Sanglah Hospital. Bali, BAL, Indonesia
Nyanza Provincial Hospital. Kisumu, KIS, Kenya
Mbarara University of Science and Technology. ISS Clinic. Mbarara, MBQ, Uganda
Lighthouse Trust. Lilongwe, LLW, Malawi
Tan Tock Seng Hospital. Singapore, SI, Singapore
Albert Einstein College of Medicine. Departments of Medicine and Epidemiology and Population Health. New York, NY, United States of America
University Hospital Bonn. Department of Internal Medicine I. Bonn, BNN, Germany
Hospital La Princesa. Madrid, MAD, Spain
National Center for Global Health and Medicine. Tokyo, TYO, Japan
National AIDS Control Program. Dar es Salaam, DAR, Tanzania
HIVCENTER am Klinikum der Johann Wolfgang Goethe-Universität. Frankfurt, FFM, Germany
Hospital Sierrallana. Torrelavega, TVG, Spain
Mulago University JHU Collaboration. Kampala, KLA, Uganda
Bern University Hospital and University of Bern. Department of Infectious Diseases. Bern, BER, Switzerland
University of Cape Town. School of Public Health and Family Medicine. Centre for Infectious Disease Epidemiology and Research. Cape Town, CPT, South Africa
Academisch Medisch Centrum bij de Universiteit van Amsterdam. Amsterdam, AMS, The Netherlands
University of Cape Town. Desmond Tutu HIV Centre. Cape Town, CPT, South Africa
Center for Infectious Disease Research in Zambia. Lusaka, LUN, Zambia
National Institute of Allergy and Infectious Diseases. Epidemiology Branch Division of AIDS. Maryland, MD, United States of America
The University of New South Wales. The Kirby Institute. Sydney, SYD, Australia
University of Bern. Institute of Social and Preventive Medicine. Finkenhubelweg, BE, Switzerland / University of Cape Town. School of Public Health and Family Medicine. Centre for Infectious Disease Epidemiology and Research. Cape Town, CPT, South Africa

Abstract

Objective: To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. Methods: Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. Results: In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): −56 to +30] lower in LMIC, 22 cells/μL (−62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage. Conclusions: Median CD4 cell counts at the start of cART increased 2000–2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.

DeCS

Antiretroviral Therapy, Highly Active
Antigens, CD4
Africa South of the Sahara
North America
West Indies
Central America
South America
Europe
Asia

Publisher

Lippincott, Williams & Wilkins

Citation

AVILA, Dorita et al. Immunodeficiency at the start of combination antiretroviral therapy in low-, middle- and high-income countries. Journal of acquired immune deficiency syndromes, v.65, n.1, p.1–19, 2014.

DOI

10.1097/QAI.0b013e3182a39979

ISSN

1525-4135

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/9992

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Open access

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