Abstract
ObjectivesUnderstanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection.MethodsHIV-infected adults (≥ 18 years old) with CD4 cell count > 500 cells/μl were enrolled in the study at three primary health care clinics, and a sociodemographic, behavioural and partnership-level questionnaire was administered. Participants were followed 6-monthly and ART eligibility was determined using a CD4 cell count threshold of 350 cells/μl. Kaplan − Meier and Cox proportional hazard regression modelling were used in the analysis.ResultsA total of 206 adults contributed 381 years of follow-up; 79 (38%) reached the ART eligibility threshold. Median time to ART eligibility was shorter for male patients (12.0 months) than for female patients (33.9 months). Male sex [adjusted hazard ratio (aHR) 3.13; 95% confidence interval (CI) 1.82–5.39], residing in a household with food shortage in the previous year (aHR 1.58; 95% CI 0.99–2.54), and taking nutritional supplements in the first 6 months after enrolment (aHR 2.06; 95% CI 1.11–3.83) were associated with shorter time to ART eligibility. Compared with reference CD4 cell count ≤ 559 cells/μl, higher CD4 cell count was associated with longer time to ART eligibility [aHR 0.46 (95% CI 0.25–0.83) for CD4 cell count 560–632 cells/μl; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/μl; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count > 768 cells/μl].ConclusionsOver one in three adults with CD4 cell count > 500 cells/μl became eligible for ART at a CD4 cell count threshold of 350 cells/μl over a median of 2 years. The shorter time to ART eligibility in male patients suggests a possible need for sex-specific pre-ART care and monitoring strategies.
Highlights
Virological and immunological factors associated with disease progression have been well characterized [4], but the impact of sociodemographic and psycho-behavioural factors on disease progression and time to antiretroviral therapy (ART) eligibility has been studied less extensively, in sub-Saharan Africa [5,6]
We used data from a longitudinal study investigating the impact of ART on the partnerships and sexual behaviour of HIV-infected individuals to explore factors associated with disease progression in adults in the early stages of HIV infection [8]
The South African guidelines for ART eligibility have changed over the course of this study: CD4 cell count < 200 cells/μl or World Health Organization (WHO) stage 4 until March 2010; CD4 cell count cut-off < 350 cells/μl for pregnant women and individuals with active tuberculosis (TB) disease from April 2010 to August 2011; < 350 cells/μl for all from August 2011
Summary
By the end of 2012, in sub-Saharan Africa, an estimated seven million people of 25 million living with HIV received antiretroviral therapy (ART) [1], but most HIV-infected people have either not yet accessed or are not yet eligible. There are few data on time to ART eligibility in those who present in early HIV infection, increasing numbers of people are diagnosed and enter care at higher CD4 cell counts [7]. We used data from a longitudinal study investigating the impact of ART on the partnerships and sexual behaviour of HIV-infected individuals to explore factors associated with disease progression in adults in the early stages of HIV infection [8]
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