Background: In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
Methods: We pooled data from 13 research cohorts in 5 sub-Saharan African (Benin, Burkina Faso, Cameroon, Cote d'Ivoire, and Senegal) and 2 Asian (Cambodia and Laos) countries. HIV-infected adults (18 years and older) who received ART in 1998–2008 and had at least one CD4 count available were eligible. Changes in CD4 counts over time were estimated by a linear mixed regression. CD4-specific incidence rates were estimated as the number of first events occurring in a given CD4 stratum divided by the time spent within the stratum.
Results: Overall 3917 adults (62% women) on ART were followed up during 10,154 person-years. In the ≤50, 51–100, 101–200, 201–350, 351–500, 501–650, and >650 cells/mm3 CD4 cells strata, death rates were 20.6, 11.8, 6.7, 3.3, 1.8, 0.9, and 0.3 per 100 person-years; AIDS rates were 50.5, 32.9, 11.5, 4.8, 2.8, 2.2, and 2.2 per 100 person-years; and loss-to-follow-up rates were 4.9, 6.1, 3.5, 3.1, 2.9, 1.7, and 1.2 per 100 person-years, respectively. Mortality and morbidity were higher during the first year after ART initiation.
Conclusions: In these resource-limited settings, death and AIDS rates remained substantial after ART initiation, even in individuals with high CD4 cell counts. Ensuring earlier ART initiation and optimizing case finding and treatment for AIDS-defining diseases should be seen as priorities.
*INSERM, U897, Bordeaux, France
†University Bordeaux, ISPED, Bordeaux, France
‡National AIDS Programme, Ministry of Health, Dakar, Senegal
§Programme PACCI, Abidjan, Côte d'Ivoire
‖Department of Clinical Immunology, Bicêtre Hospital, Kremlin Bicêtre, France
¶ESTHER/Calmette Hospital, Phnom Penh, Cambodia
#Programme MTCT-Plus, ACONDA, Abidjan, Côte d'Ivoire
**Epicentre, Paris, France
††Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMI 233, Montpellier, France
‡‡SEAD (Sharing Experience for Adapted Development), Phnom Penh, Cambodia
§§Institut Pasteur, Phnom Penh, Cambodia
‖‖Centre Muraz, Bobo-Dioulasso, Burkina Faso
¶¶Virology laboratory IRD/IMPM/CREMER, UMI 233, Yaoundé, Cameroon
##Central Hospital, UMI 233, Yaoundé, Cameroon
***University Yaoundé 1, UMI 233, Yaoundé, Cameroon
†††Centre National Hospitalier Universitaire Cotonou, Cotonou, Benin
‡‡‡Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Benin.
Correspondence to: Delphine Gabillard, MSc, INSERM U897, ISPED, Université Bordeaux Segalen, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France (e-mail: firstname.lastname@example.org).
Supported by the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Grant ANRS 12222.
These data were presented at the 6th AFRAVIH, March 25–28, 2012, Switzerland and at the 16th ICASA 2011, December 4–8, 2011, Addis Ababa, Ethiopia.
The authors have no conflicts of interest to disclose.
Received July 27, 2012
Accepted December 04, 2012