Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda

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dc.contributor.authorBray, Sarah
dc.contributor.authorGedeon, Jillian
dc.contributor.authorHadi, Ahsan
dc.contributor.authorKotb, Ahmed
dc.contributor.authorRahman, Tarun
dc.contributor.authorSarwar, Elaha
dc.contributor.authorSavelyeva, Anna
dc.contributor.authorSévigny, Marika
dc.contributor.authorBakanda, Celestin
dc.contributor.authorBirungi, Josephine
dc.contributor.authorChan, Keith
dc.contributor.authorYaya, Sanni
dc.contributor.authorDeonandan, Raywat
dc.contributor.authorMills, Edward J.
dc.date.accessioned2018-07-24T13:50:08Z
dc.date.available2018-07-24T13:50:08Z
dc.date.issued2012
dc.descriptionAlthough international guidelines recommend initiating antiretroviral therapy (ART) when a patient’s CD4 cell count is <350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda.en_US
dc.description.abstractObjective: Although international guidelines recommend initiating antiretroviral therapy (ART) when a patient’s CD4 cell count is <350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda. Design: This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda. Methods: We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (<50, 50–99, 100–149, 150–249, 250+ cells/μL). We constructed Kaplan–Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up. Results: Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150–249, hazard ratio [HR] 0.60, 95% confidence interval [CI]: 0.45–0.82, P = 0.001; 250+, HR 0.66, 95% CI, 0.44–1.00, P = −0.05). Male sex, older age, and duration of time on ART were independently associated with mortality. When left-censoring at 2 years, CD4 nadir was no longer statistically significantly associated with mortality. Conclusion: After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda. This should argue for efforts to increase engagement with patients to ensure a higher CD4 nadir at initiation of treatment.en_US
dc.identifier.citationBray, Sarah, Gedeon, Jillian, Hadi, Ahsan, Kotb, Ahmed, Rahman, Tarun, Sarwar, Elaha, Savelyeva, Anna, Sévigny, Marika, Bakanda, Celestin, Birungi, Josephine, Chan, Keith, Yaya, Sanni, Deonandan, Raywat, Mills, Edward J. 2012. Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda.en_US
dc.identifier.urihttps://hdl.handle.net/20.500.11951/270
dc.language.isoenen_US
dc.publisherDovepressen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectARTen_US
dc.subjectCD4en_US
dc.subjectPrognosisen_US
dc.subjectSub-Saharan Africaen_US
dc.titlePredictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Ugandaen_US
dc.typeArticleen_US
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The final, definitive version of this paper has been published in the HIV/AIDS – Research and Palliative Care Vol.4, 16 August/2012. http://dx.doi.org/10.2147/HIV.S35374; Published by Dovepress all rights reserved.
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