CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: Multicohort analysis from South Africa

Christopher J. Hoffmann, Michael Schomaker, Matthew P. Fox, Portia Mutevedzi, Janet Giddy, Hans Prozesky, Robin Wood, Daniela B. Garone, Matthias Egger, Andrew Boulle

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information. METHODS: We analyzed data from a large multicohort study in South Africa, where HIV RNA is routinely monitored. Adult HIV-positive patients initiating cART between 2003 and 2010 were included. Mortality was analyzed in Cox models; CD4 count slope by HIV RNA level was assessed using linear mixed models. RESULTS: About 44,829 patients (median age: 35 years, 58% female, median CD4 count at cART initiation: 116 cells/mm) were followed up for a median of 1.9 years, with 3706 deaths. Mean CD4 count slopes per week ranged from 1.4 [95% confidence interval (CI): 1.2 to 1.6] cells per cubic millimeter when HIV RNA was <400 copies per milliliter to -0.32 (95% CI: -0.47 to -0.18) cells per cubic millimeter with >100,000 copies per milliliter. The association of CD4 slope with mortality depended on current CD4 count: the adjusted hazard ratio (aHRs) comparing a >25% increase over 6 months with a >25% decrease was 0.68 (95% CI: 0.58 to 0.79) at <100 cells per cubic millimeter but 1.11 (95% CI: 0.78 to 1.58) at 201-350 cells per cubic millimeter. In contrast, the aHR for current CD4 count, comparing >350 with <100 cells per cubic millimeter, was 0.10 (95% CI: 0.05 to 0.20). CONCLUSIONS: Absolute CD4 count remains a strong risk for mortality with a stable effect size over the first 4 years of cART. However, CD4 count slope and HIV RNA provide independently added to the model.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume63
Issue number1
DOIs
StatePublished - May 1 2013

Keywords

  • CD4 count slope
  • HIV
  • HIV RNA
  • antiretroviral therapy
  • mortality
  • resource-limited setting

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: Multicohort analysis from South Africa'. Together they form a unique fingerprint.

  • Cite this