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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182821821
Epidemiology and Prevention

Mortality, AIDS-Morbidity, and Loss to Follow-up by Current CD4 Cell Count Among HIV-1–Infected Adults Receiving Antiretroviral Therapy in Africa and Asia: Data From the ANRS 12222 Collaboration

Gabillard, Delphine MSc*,†; Lewden, Charlotte MD, PhD*,†; Ndoye, Ibra MD; Moh, Raoul MD, MSc§; Segeral, Olivier MD‖,¶; Tonwe-Gold, Besigin MD, MSc#; Etard, Jean-François MD, PhD**,††; Pagnaroat, Men MD‡‡; Fournier-Nicolle, Isabelle MD§§; Eholié, Serge MD, PhD§; Konate, Issouf MD‖‖; Minga, Albert MD, PhD§; Mpoudi-Ngole, Eitel MD¶¶; Koulla-Shiro, Sinata MD##,***; Zannou, Djimon Marcel MD, PhD†††,‡‡‡; Anglaret, Xavier MD, PhD*,†,§; Laurent, Christian PhD††; for The ANRS 12222 MorbidityMortality Study Group

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Abstract

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.

© 2013 Lippincott Williams & Wilkins, Inc.

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