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Time to eligibility for antiretroviral therapy in adults with CD4+ cell count >500 cells/µl in rural KwaZulu-Natal, South Africa

Time to eligibility for antiretroviral therapy in adults with CD4+ cell count >500 cells/µl in rural KwaZulu-Natal, South Africa
Time to eligibility for antiretroviral therapy in adults with CD4+ cell count >500 cells/µl in rural KwaZulu-Natal, South Africa
Objectives

Understanding 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.

Methods

HIV-infected adults (??18 years old) with CD4 cell count >?500 cells/?l 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/?l. Kaplan???Meier and Cox proportional hazard regression modelling were used in the analysis.

Results

A 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/?l, 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/?l; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/?l; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count?>?768 cells/?l].

Conclusions

Over one in three adults with CD4 cell count?>?500 cells/?l became eligible for ART at a CD4 cell count threshold of 350 cells/?l 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.
antiretroviral therpy, HIV, Sub-Saharan Africa
1464-2662
512-518
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Lessells, R.J.
54b2808f-a135-46ea-92df-ad2e6512dbf8
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Lessells, R.J.
54b2808f-a135-46ea-92df-ad2e6512dbf8
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3

McGrath, N., Lessells, R.J. and Newell, M.L. (2015) Time to eligibility for antiretroviral therapy in adults with CD4+ cell count >500 cells/µl in rural KwaZulu-Natal, South Africa. HIV Medicine, 16 (8), 512-518. (doi:10.1111/hiv.12255). (PMID:25959724)

Record type: Article

Abstract

Objectives

Understanding 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.

Methods

HIV-infected adults (??18 years old) with CD4 cell count >?500 cells/?l 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/?l. Kaplan???Meier and Cox proportional hazard regression modelling were used in the analysis.

Results

A 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/?l, 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/?l; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/?l; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count?>?768 cells/?l].

Conclusions

Over one in three adults with CD4 cell count?>?500 cells/?l became eligible for ART at a CD4 cell count threshold of 350 cells/?l 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.

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More information

Accepted/In Press date: 16 January 2015
e-pub ahead of print date: 11 May 2015
Published date: September 2015
Keywords: antiretroviral therpy, HIV, Sub-Saharan Africa
Organisations: Primary Care & Population Sciences, Faculty of Social, Human and Mathematical Sciences

Identifiers

Local EPrints ID: 374018
URI: http://eprints.soton.ac.uk/id/eprint/374018
ISSN: 1464-2662
PURE UUID: 9b2f84a9-bfa5-4c0d-813d-c2ef765d0719
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159
ORCID for M.L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 03 Feb 2015 14:41
Last modified: 03 Dec 2019 01:36

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