Advanced HIV disease in East Africa and Nigeria, in The African Cohort Study.

Autor: Oboho IK; HIV Care and Treatment Branch, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA., Esber AL; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; Henry M. Jackson Foundation (HJF) for the Advancement of Military Medicine, Inc., Bethesda, MD., Dear N; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; Henry M. Jackson Foundation (HJF) for the Advancement of Military Medicine, Inc., Bethesda, MD., Paulin HN; HIV Care and Treatment Branch, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA., Iroezindu M; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; HJF Medical Research International, Abuja, Nigeria., Bahemana E; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; HJF Medical Research International, Mbeya, Tanzania., Kibuuka H; Makerere University Walter Reed Project, Kampala, Uganda., Owuoth J; U.S. Army Medical Research Directorate-Africa, Kisumu, Kenya.; HJF Medical Research International, Kisumu, Kenya ; and., Maswai J; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; U.S. Army Medical Research Directorate-Africa, Kericho, Kenya ., Shah N; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD., Crowell TA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; Henry M. Jackson Foundation (HJF) for the Advancement of Military Medicine, Inc., Bethesda, MD., Ake JA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD., Polyak CS; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.; Henry M. Jackson Foundation (HJF) for the Advancement of Military Medicine, Inc., Bethesda, MD.
Jazyk: angličtina
Zdroj: Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2024 May 01; Vol. 96 (1), pp. 51-60. Date of Electronic Publication: 2024 Apr 10.
DOI: 10.1097/QAI.0000000000003392
Abstrakt: Background: Earlier antiretroviral therapy (ART) may decrease progression to advanced HIV disease (AHD) with CD4 count of <200 cells per cubic millimeter or clinical sequelae. We assessed factors associated with AHD among people living with HIV before and during the "test and treat" era.
Setting: The African Cohort Study prospectively enrolls adults with and without HIV from 12 clinics in Uganda, Kenya, Tanzania, and Nigeria.
Methods: Enrollment evaluations included clinical history, physical examination, and laboratory testing. Generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals for factors associated with CD4 count of <200 cells per cubic millimeter at study visits.
Results: From 2013 to 2021, 3059 people living with HIV with available CD4 at enrollment were included; median age was 38 years [interquartile range: 30-46 years], and 41.3% were men. From 2013 to 2021, the prevalence of CD4 count of <200 cells per cubic millimeter decreased from 10.5% to 3.1%, whereas the percentage on ART increased from 76.6% to 100% ( P <0.001). Factors associated with higher odds of CD4 count of <200 cells per cubic millimeter were male sex (adjusted odds ratio 1.56 [confidence interval: 1.29 to 1.89]), being 30-39 years (1.42 [1.11-1.82]) or older (compared with <30), have World Health Organization stage 2 disease (1.91 [1.48-2.49]) or higher (compared with stage 1), and HIV diagnosis eras 2013-2015 (2.19 [1.42-3.37]) or later (compared with <2006). Compared with ART-naive, unsuppressed participants, being viral load suppressed on ART, regardless of ART duration, was associated with lower odds of CD4 count of <200 cells per cubic millimeter (<6 months on ART: 0.45 [0.34-0.58]).
Conclusion: With ART scale-up, AHD has declined. Efforts targeting timely initiation of suppressive ART may further reduce AHD risk.
Competing Interests: The authors have no funding or conflicts of interest to disclose.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze: MEDLINE