Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda

Mills EJ, Bakanda C, Birungi J, Mwesigwa R, Chan K, Ford N, Hogg RS, Cooper C.

aFaculty of Health Sciences, University of Ottawa, Ottawa, Canada bThe AIDS Support Organization (TASO), Headquarters, Kampala, Uganda cBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada dMédecins Sans Frontiers (MSF), Geneva, Switzerland eDivision of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada.
Abstract
OBJECTIVE: Evaluations of CD4 cell count and other prognostic factors on the survival of HIV patients in sub-Saharan are extremely limited. Funders have been reticent to recommend earlier initiation of treatment. We aimed to examine the effect of baseline CD4 cell count on mortality using data from HIV patients receiving combination antiretroviral therapy (cART) in Uganda.
DESIGN: Observational study of patients age ≥14 years) enrolled in 10 clinics across Uganda for which TASO has data.
METHODS: CD4 cell count was stratified into categories (<50, 50-99, 100-149, 150-199, 200-249, 250-299, ≥300 cells/mm) and Cox proportional hazards regression was used to model the associations between CD4 cell count and mortality.
RESULTS: 22 315 patients were included. 1498 patients died during follow-up (6.7%) and 1433 (6.4%) of patients were lost to follow-up. Crude mortality rates (CMR) ranged from 53.8 per 1000 patient years (95% Confidence Interval [CI], 48.8-58.8) among those with CD4 cell counts of <50, to 15.7, (95% CI, 12.1-19.3) among those with ≥300 cells/mm. Relative to a baseline CD4 cell count of <50 cells/mm, the risk of mortality was 0.75 (95% CI, 0.65-0.88), 0.60 (95% CI, 0.51-0.70), 0.43 (0.37-0.50), and 0.41 (0.33-0.51) for those with baseline CD4 cell counts of 50-99, 100-149, 150-249, and ≥250 cells/mm, respectively.
CONCLUSION: Earlier initiation of cART is associated with increased survival benefits over deferred treatment.

PMID: 21330903 [PubMed - as supplied by publisher]