Abstract
BackgroundWe describe CD4 count recovery among HIV positive individuals who initiated antiretroviral therapy (ART) with and without severe immune suppression using complete laboratory data from South Africa’s national HIV treatment programme between 2010 and 2014 and discuss implications for CD4 count monitoring.MethodsRetrospective analysis of routinely collected laboratory data from South Africa’s National Health Laboratory Service (NHLS). A probabilistic record linkage algorithm was used to create a cohort of HIV positive individuals who initiated ART between 2010 and 2014 based on timing of CD4 count and viral load measurements. A CD4 count < 50 copies/μl at ART initiation was considered severe immunosuppression. A multivariable piecewise mixed-effects linear regression model adjusting for age, gender, year of starting ART, viral suppression in follow up and province was used to predict CD4 counts during follow up.Results1,070,900 individuals had evidence of starting ART during 2010–2014 and met the criteria for inclusion in the cohort -46.6% starting ART with CD4 < 200 cells/μl and 10.1% with CD4 < 50 cells/ μl. For individuals with CD4 counts < 200 cells/μl, predicted CD4 counts > 200 cells/μl, >350 cells/μl and >500 cells/μl corresponded with mean follow up durations of 1.5 years (standard deviation [s.d] 1.1), 1.9years (s.d 1.2) and 2.1 years (s.d 1.3 years). For those with CD4 counts < 50 cells/μl, predicted CD4 count above these threshold corresponded with mean follow up durations of 2.5 years (s.d 0.9 years), 4.4 years (s.d 0.4 years) and 5.0 years (s.d 0.1years) for recovery to the same thresholds. CD4 count recovery varied mostly with duration on ART, CD4 count at the start of ART and gender.ConclusionFor individuals starting with ART with severe immunosuppression, CD4 recovery to 200cells/μl did not occur or took longer than 12 month for significant proportions. CD4 monitoring and interventions recommended for advanced HIV disease should continue until full recovery.
Highlights
Antiretroviral therapy (ART) reduces mortality and morbidity among HIV positive individuals as well as the onward transmission of HIV. [1,2,3] Untreated HIV infection is associated with decreases in CD4 count levels and increases in HIV plasma viral loads. [4]The initiation of antiretroviral therapy (ART) is typically followed by declines in viral loads and increases in CD4 count
For individuals starting with ART with severe immunosuppression, CD4 recovery to 200cells/μl did not occur or took longer than 12 month for significant proportions
Antiretroviral therapy (ART) reduces mortality and morbidity among HIV positive individuals as well as the onward transmission of HIV. [1,2,3] Untreated HIV infection is associated with decreases in CD4 count levels and increases in HIV plasma viral loads. [4]The initiation of ART is typically followed by declines in viral loads and increases in CD4 count
Summary
Antiretroviral therapy (ART) reduces mortality and morbidity among HIV positive individuals as well as the onward transmission of HIV. [1,2,3] Untreated HIV infection is associated with decreases in CD4 count levels and increases in HIV plasma viral loads. [4]The initiation of ART is typically followed by declines in viral loads and increases in CD4 count. CD4 count recovery following ART initiation is rapid in the first few months, as a result of redistribution of the existing CD4 cells from lymphoid organs, and slows down as new CD4 cells are made as a result of thymic activation.[5,6] A number of factors are known to affect the extent of CD4 count recovery post ART initiation These include CD4 count at ART initiation, gender -with males found to have lower CD4 recovery compared to females in some settings, [7] older age, [8,9] duration on ART and ART regimen, [10] as well as genetic and environmental factors that contribute to immune activation.[6]. We describe CD4 count recovery among HIV positive individuals who initiated antiretroviral therapy (ART) with and without severe immune suppression using complete laboratory data from South Africa’s national HIV treatment programme between 2010 and 2014 and discuss implications for CD4 count monitoring
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