Higher Baseline CD4 Cell Count Predicts Treatment Interruptions and Persistent Viremia in Patients Initiating ARVs in Rural Uganda

Adakun, Susan A. MD*; Siedner, Mark J. MD, MPH; Muzoora, Conrad MD*; Haberer, Jessica E. MD, MS; Tsai, Alexander C. MD§; Hunt, Peter W. MD; Martin, Jeff N. MD, MPH; Bangsberg, David R. MD, MPH*,†,#

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182800daf
Brief Report: Clinical Science

Abstract: We examined the association between CD4 cell count and adherence in a cohort of Ugandans initiating antiretrovirals (ARVs). Outcomes were (a) adherence <90%; (b) any treatment interruptions > 72 hours; (c) number of treatment interruptions; and (d) HIV-RNA >400 copies/mL. We fit regression models to estimate associations with our exposure of interest, baseline CD4 cell count ≥ 250 cells/μL (n = 60) vs <250 cells/μL (n = 413). CD4 cell count ≥250 cells/μL was independently associated with increased odds and number of treatment interruptions and increased odds of persistent viremia. Interventions to support adherence in patients with higher CD4 cell counts should be considered as drug availability to this population increases.

Author Information

*Department of Medicine, Mbarara University of Science and Technology, Mbara, Uganda; Divisions of

Infectious Disease and

Internal Medicine, Department of Medicine, and the

§Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Center for Global Health, Boston, MA

Division of Infectious Disease, Department of Medicine, and the

Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA

#Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard Medical School, Boston, MA.

Correspondence to: Susan A. Adakun, MD, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda (e-mail: adakunsusan@yahoo.com).

Support for the Uganda AIDS Rural Treatment Outcomes Study (UARTO) is provided by US National Institutes of Health R01 MH54907 and P30 AI27763. The authors also acknowledge the following additional sources of salary support: NIH K23 MH087228 (Haberer); NIH K23 MH096620 (Tsai); NIH K24 MH87227 (Bangsberg); the Harvard Institute for Global Health, the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988), and NIH T32 AI007433 (Siedner). Additional study funding was provided by the Mark and Lisa Schwartz Family Foundation, the Sullivan Family Foundation, and the Bacca Foundation.

Presented at the 7th Conference of the International Association of Physicians in AIDS Care, June 2012, Miami, FL.

The authors have no conflicts of interest to disclose.

Received September 12, 2012

Accepted November 27, 2012

© 2013 Lippincott Williams & Wilkins, Inc.