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Title: Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients
Authors: Sasisopin Kiertiburanakul
David Boettiger
Man Po Lee
Sharifah Fs Omar
Junko Tanuma
Oon Tek Ng
Nicolas Durier
Praphan Phanuphak
Rossana Ditangco
Romanee Chaiwarith
Pacharee Kantipong
Christopher Kc Lee
Mahiran Mustafa
Vonthanak Saphonn
Winai Ratanasuwan
Tuti Parwati Merati
Nagalingeswaran Kumarasamy
Wing Wai Wong
Fujie Zhang
Thanh Thuy Pham
Sanjay Pujari
Jun Yong Choi
Evy Yunihastuti
Somnuek Sungkanuparph
Mahidol University
University of New South Wales (UNSW) Australia
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
National Center for Global Health and Medicine
Tan Tock Seng Hospital
amfAR - The Foundation for AIDS Research
The HIV Netherlands Australia Thailand Research Collaboration
Chiang Mai University
Chiangrai Prachanukroh Hospital
Hospital Sungai Buloh
Hospital Raja Perempuan Zainab II
National Center for HIV/AIDS
Universitas Udayana
YR Gaitonde Centre for AIDS Research and Education
National Yang-Ming University Taiwan
Beijing Ditan Hospital
Bach Mai Hospital
Institute of Infectious Diseases
Yonsei University College of Medicine
University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
Keywords: Medicine
Issue Date: 14-Mar-2014
Citation: Journal of the International AIDS Society. Vol.17, (2014)
Abstract: Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented. © 2014 Kiertiburanakul S et al; licensee International AIDS Society.
ISSN: 17582652
Appears in Collections:Scopus 2011-2015

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