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

Dorita Avila; Keri N Althoff; Catrina Mugglin; Kara Wools-Kaloustian; Manuel Koller; François Dabis; Denis Nash; Thomas Gsponer; Somnuek Sungkanuparph; Catherine McGowan; Margaret May; David Cooper; Cleophas Chimbetete; Marcelo Wolff; Ann Collier; Hamish McManus; Mary-Ann Davies; Dominique Costagliola; Brenda Crabtree-Ramirez; Romanee Chaiwarith; Angela Cescon; Morna Cornell; Lameck Diero; Praphan Phanuphak; Adrien Sawadogo; Jochen Ehmer; Serge P Eholie; Patrick C K Li; Matthew P Fox; Neel R Gandhi; Elsa González; Christopher K C Lee; Christopher J Hoffmann; Andrew Kambugu; Olivia Keiser; Rossana Ditangco; Hans Prozesky; Fiona Lampe; Nagalingeswaran Kumarasamy; Mari Kitahata; Emmanuel Lugina; Rita Lyamuya; Saphonn Vonthanak; Valeria Fink; Antonella d'Arminio Monforte; Paula Mendes Luz; Yi-Ming A Chen; Albert Minga; Jonathan A Sterne; Matthias Egger; IeDEA and ART Cohort Collaborations

doi:10.1097/QAI.0b013e3182a39979

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

Dorita Avila, Keri N Althoff, Catrina Mugglin, Kara Wools-Kaloustian, Manuel Koller, François Dabis, Denis Nash, Thomas Gsponer, Somnuek Sungkanuparph, Catherine McGowan, Margaret May, David Cooper, Cleophas Chimbetete, Marcelo Wolff, Ann Collier, Hamish McManus, Mary-Ann Davies, Dominique Costagliola, Brenda Crabtree-Ramirez, Romanee ChaiwarithAngela Cescon, Morna Cornell, Lameck Diero, Praphan Phanuphak, Adrien Sawadogo, Jochen Ehmer, Serge P Eholie, Patrick C K Li, Matthew P Fox, Neel R Gandhi, Elsa González, Christopher K C Lee, Christopher J Hoffmann, Andrew Kambugu, Olivia Keiser, Rossana Ditangco, Hans Prozesky, Fiona Lampe, Nagalingeswaran Kumarasamy, Mari Kitahata, Emmanuel Lugina, Rita Lyamuya, Saphonn Vonthanak, Valeria Fink, Antonella d'Arminio Monforte, Paula Mendes Luz, Yi-Ming A Chen, Albert Minga, Jonathan A Sterne, Matthias Egger, IeDEA and ART Cohort Collaborations

Research output: Contribution to journal › Article (Academic Journal) › peer-review

133 Citations (Scopus)

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.

Original language	English
Pages (from-to)	e8-16
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	65
Issue number	1
DOIs	https://doi.org/10.1097/QAI.0b013e3182a39979
Publication status	Published - 1 Jan 2014

Keywords

Adolescent
Adult
Age Factors
Anti-HIV Agents
CD4 Lymphocyte Count
Developed Countries
Developing Countries
Female
HIV Infections
Humans
Male
Sex Factors
Young Adult

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAI.0b013e3182a39979

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ART-CC: Prognosis of HIV-infected patients treated with ART
Sterne, J. A. C., Ingle, S. M. & May, M. T.
1/02/12 → 1/02/15
Project: Research
MONITORING AND MODELLING PROGNOSIS IN THE ERA OF HAART
Sterne, J. A. C.
1/02/08 → 1/02/11
Project: Research

Professor Jonathan A C Sterne
- Jonathan.Sternebristol.acuk
- Bristol Medical School (PHS) - Professor of Medical Statistics and Epidemiology
- Bristol Population Health Science Institute
- Infection and Immunity
Person: Academic , Member

Cite this

Avila, D., Althoff, K. N., Mugglin, C., Wools-Kaloustian, K., Koller, M., Dabis, F., Nash, D., Gsponer, T., Sungkanuparph, S., McGowan, C., May, M., Cooper, D., Chimbetete, C., Wolff, M., Collier, A., McManus, H., Davies, M.-A., Costagliola, D., Crabtree-Ramirez, B., ... IeDEA and ART Cohort Collaborations (2014). Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. Journal of Acquired Immune Deficiency Syndromes, 65(1), e8-16. https://doi.org/10.1097/QAI.0b013e3182a39979

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

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.",

keywords = "Adolescent, Adult, Age Factors, Anti-HIV Agents, CD4 Lymphocyte Count, Developed Countries, Developing Countries, Female, HIV Infections, Humans, Male, Sex Factors, Young Adult",

author = "Dorita Avila and Althoff, {Keri N} and Catrina Mugglin and Kara Wools-Kaloustian and Manuel Koller and Fran{\c c}ois Dabis and Denis Nash and Thomas Gsponer and Somnuek Sungkanuparph and Catherine McGowan and Margaret May and David Cooper and Cleophas Chimbetete and Marcelo Wolff and Ann Collier and Hamish McManus and Mary-Ann Davies and Dominique Costagliola and Brenda Crabtree-Ramirez and Romanee Chaiwarith and Angela Cescon and Morna Cornell and Lameck Diero and Praphan Phanuphak and Adrien Sawadogo and Jochen Ehmer and Eholie, {Serge P} and Li, {Patrick C K} and Fox, {Matthew P} and Gandhi, {Neel R} and Elsa Gonz{\'a}lez and Lee, {Christopher K C} and Hoffmann, {Christopher J} and Andrew Kambugu and Olivia Keiser and Rossana Ditangco and Hans Prozesky and Fiona Lampe and Nagalingeswaran Kumarasamy and Mari Kitahata and Emmanuel Lugina and Rita Lyamuya and Saphonn Vonthanak and Valeria Fink and {d'Arminio Monforte}, Antonella and Luz, {Paula Mendes} and Chen, {Yi-Ming A} and Albert Minga and Sterne, {Jonathan A} and Matthias Egger and {IeDEA and ART Cohort Collaborations}",

year = "2014",

month = jan,

day = "1",

doi = "10.1097/QAI.0b013e3182a39979",

language = "English",

volume = "65",

pages = "e8--16",

journal = "Journal of Acquired Immune Deficiency Syndromes",

issn = "1944-7884",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Avila, D, Althoff, KN, Mugglin, C, Wools-Kaloustian, K, Koller, M, Dabis, F, Nash, D, Gsponer, T, Sungkanuparph, S, McGowan, C, May, M, Cooper, D, Chimbetete, C, Wolff, M, Collier, A, McManus, H, Davies, M-A, Costagliola, D, Crabtree-Ramirez, B, Chaiwarith, R, Cescon, A, Cornell, M, Diero, L, Phanuphak, P, Sawadogo, A, Ehmer, J, Eholie, SP, Li, PCK, Fox, MP, Gandhi, NR, González, E, Lee, CKC, Hoffmann, CJ, Kambugu, A, Keiser, O, Ditangco, R, Prozesky, H, Lampe, F, Kumarasamy, N, Kitahata, M, Lugina, E, Lyamuya, R, Vonthanak, S, Fink, V, d'Arminio Monforte, A, Luz, PM, Chen, Y-MA, Minga, A, Sterne, JA , Egger, M & IeDEA and ART Cohort Collaborations 2014, 'Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries', Journal of Acquired Immune Deficiency Syndromes, vol. 65, no. 1, pp. e8-16. https://doi.org/10.1097/QAI.0b013e3182a39979

TY - JOUR

T1 - Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries

AU - Avila, Dorita

AU - Althoff, Keri N

AU - Mugglin, Catrina

AU - Wools-Kaloustian, Kara

AU - Koller, Manuel

AU - Dabis, François

AU - Nash, Denis

AU - Gsponer, Thomas

AU - Sungkanuparph, Somnuek

AU - McGowan, Catherine

AU - May, Margaret

AU - Cooper, David

AU - Chimbetete, Cleophas

AU - Wolff, Marcelo

AU - Collier, Ann

AU - McManus, Hamish

AU - Davies, Mary-Ann

AU - Costagliola, Dominique

AU - Crabtree-Ramirez, Brenda

AU - Chaiwarith, Romanee

AU - Cescon, Angela

AU - Cornell, Morna

AU - Diero, Lameck

AU - Phanuphak, Praphan

AU - Sawadogo, Adrien

AU - Ehmer, Jochen

AU - Eholie, Serge P

AU - Li, Patrick C K

AU - Fox, Matthew P

AU - Gandhi, Neel R

AU - González, Elsa

AU - Lee, Christopher K C

AU - Hoffmann, Christopher J

AU - Kambugu, Andrew

AU - Keiser, Olivia

AU - Ditangco, Rossana

AU - Prozesky, Hans

AU - Lampe, Fiona

AU - Kumarasamy, Nagalingeswaran

AU - Kitahata, Mari

AU - Lugina, Emmanuel

AU - Lyamuya, Rita

AU - Vonthanak, Saphonn

AU - Fink, Valeria

AU - d'Arminio Monforte, Antonella

AU - Luz, Paula Mendes

AU - Chen, Yi-Ming A

AU - Minga, Albert

AU - Sterne, Jonathan A

AU - Egger, Matthias

AU - IeDEA and ART Cohort Collaborations

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Anti-HIV Agents

KW - CD4 Lymphocyte Count

KW - Developed Countries

KW - Developing Countries

KW - Female

KW - HIV Infections

KW - Humans

KW - Male

KW - Sex Factors

KW - Young Adult

U2 - 10.1097/QAI.0b013e3182a39979

DO - 10.1097/QAI.0b013e3182a39979

M3 - Article (Academic Journal)

C2 - 24419071

SN - 1944-7884

VL - 65

SP - e8-16

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

IS - 1

ER -

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

Abstract

Keywords

UN SDGs

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Projects

ART-CC: Prognosis of HIV-infected patients treated with ART

MONITORING AND MODELLING PROGNOSIS IN THE ERA OF HAART

Profiles

Professor Jonathan A C Sterne

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