Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda.

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dc.contributor.authorMills, Edward J.
dc.contributor.authorBakanda, Celestin
dc.contributor.authorBirungi, Josephine
dc.contributor.authorMwesigwa, Robert
dc.contributor.authorChan, Keith
dc.contributor.authorFord, Nathan
dc.contributor.authorHogg, Robert S.
dc.contributor.authorCooper, Curtis
dc.date.accessioned2018-07-24T09:55:26Z
dc.date.available2018-07-24T09:55:26Z
dc.date.issued2011
dc.descriptionThe study aimed to examine the effect of baseline CD4 cell count on mortality using data from HIV patients receiving combination antiretroviral therapy (cART) in Uganda.en_US
dc.description.abstractObjective: Evaluations of CD4 cell count and other prognostic factors on the survival of HIV patients in sub-Saharan Africa are extremely limited. Funders have been reticent to recommend earlier initiation of treatment. We aimed to examine the effect of baseline CD4 cell count on mortality using data from HIV patients receiving combination antiretroviral therapy (cART) in Uganda. Design: Observational study of patients aged at least 14 years enrolled in 10 clinics across Uganda for which The AIDS Support Organization (TASO) has data. Methods: CD4 cell count was stratified into categories (<50, 50–99, 100–149, 150–199, 200–249, 250–299, >300 cells/ml) and Cox proportional hazards regression was used to model the associations between CD4 cell count and mortality. Results: A total of 22 315 patients were included. 1498 patients died during follow-up (6.7%) and 1433 (6.4%) of patients were lost to follow-up. Crude mortality rates (CMRs) ranged from 53.8 per 1000 patient-years [95% confidence interval (CI) 48.8–58.8] among those with CD4 cell counts of less than 50, to 15.7, (95% CI 12.1–19.3) among those with at least 300 cells/ml. Relative to a baseline CD4 cell count of less than 50 cells/ml, the risk of mortality was 0.75 (95% CI 0.65–0.88), 0.60 (95% CI 0.51–0.70), 0.43 (0.37–0.50), and 0.41 (0.33–0.51) for those with baseline CD4 cell counts of 50–99, 100–149, 150–249, and >250 cells/ml, respectively. Conclusion: Earlier initiation of cART is associated with increased survival benefits over deferred treatment.en_US
dc.identifier.citationMills, Edward J., Bakanda, Celestin, Birungi, Josephine, Mwesigwa, Robert, Chan, Keith, Ford, Nathan, Hogg, Robert S. and Cooper, Curtis, 2011. Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda.en_US
dc.identifier.urihttps://hdl.handle.net/20.500.11951/263
dc.language.isoenen_US
dc.publisherLippincott Williams & Wilkins, Inc.en_US
dc.subjectAntiretroviral therapyen_US
dc.subjectCD4en_US
dc.subjectHIVen_US
dc.subjectMortalityen_US
dc.subjectSub-Saharan Africaen_US
dc.subjectUgandaen_US
dc.titleMortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda.en_US
dc.typeArticleen_US
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The final, definitive version of this paper has been published in the Wolters Kluwer Health, Vol.25, Issue 6. 2011. doi: 10.1097/QAD.0b013e32834564e9; published by Lippincott Williams & Wilkins.
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