Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study

Zhenzhu Tang,Xuanhua Liu,Guanghua Lan,Qiuying Zhu,Yiming Shao,Yuhua Ruan,Lingjie Liao,Hui Xing,Heng Zhang,Jinming Su,Stephen W Pan,Yi Feng,Zhiyong Shen,Yi Chen

doi:10.1038/s41598-017-03384-7

Abstract

Current WHO guidelines recommend initiating ART regardless of CD4+ cell count. In response, we conducted an observational cohort study to assess the effects of pre-ART CD4+ cell count levels on death, attrition, and death or attrition in HIV treated patients. This large HIV treatment cohort study (n = 49,155) from 2010 to 2015 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between pre-ART CD4+ cell counts and death, attrition, and death or attrition. The average mortality and ART attrition rates among all treated patients were 2.63 deaths and 5.32 attritions per 100 person-years, respectively. Compared to HIV patients with <350 CD4+ cells/mm3 at ART initiation, HIV patients with >500 CD4+ cells/mm3 at ART initiation had a significantly lower mortality rate (Adjusted hazard ratio: 0.56, 95% CI: 0.40–0.79), but significantly higher ART attrition rate (AHR: 1.17, 95% CI: 1.03–1.33). Results from this study suggest that HIV patients with high CD4+ cell counts at the time of ART initiation may be at greater risk of treatment attrition. To further reduce ART attrition, it is imperative that patient education and healthcare provider training on ART adherence be enhanced and account for CD4 levels at ART initiation.

Highlights

ART attrition, it is imperative that patient education and healthcare provider training on ART adherence be enhanced and account for CD4 levels at ART initiation
Research in recent years has indicated that early initiation of ART can delay time to AIDS-related events and decrease incidences of morbidity and mortality, and high current CD4+ T cell count can be associated with suboptimal adherence to ART11–17
Given the clinical benefits and significant reductions in HIV transmission associated with early ART initiation, the World Health Organization (WHO) revised their ART guidelines in 2010 by increasing the threshold for ART eligibility in developed countries from

Summary

Introduction

ART attrition, it is imperative that patient education and healthcare provider training on ART adherence be enhanced and account for CD4 levels at ART initiation. Given the clinical benefits and significant reductions in HIV transmission associated with early ART initiation, the World Health Organization (WHO) revised their ART guidelines in 2010 by increasing the threshold for ART eligibility in developed countries from

Methods

Results

Conclusion